HomeMy WebLinkAboutPermit Septic Tank 1981-4-23
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CONSTRU.CTION/PLACEMENT
PERMIT
FOR OFFICE USE ONLY
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COMPLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT.
~'"'roi-n:bHII/ / \ RANGE ~.3 SECT3$ /' / ._ ~O OOU1' oj;'
:;UBDIVISION/PARTITION ("if applicalJlej. I r;01'/PARCEL. I BLOCK
LOC.20N ADDRESS ~~ ~ ~ CITY ZIP
'~~=VI..o/?~./~ ~/
'-bESC - ON OF ~R';;~~~ LA ~ ~~~~
DROor'lS_~ # OF STO~Sh ) ~EES /. WAT~PPry /. 0 p_r<;,po~ed
C7) V~ 41/& /./~~~/ ~ustl.ng
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1 - /..!AVE CAREFULI.Y EXAMINED THE COMPLETED APPLICATION FOR PERMIT, and do hereby certify tha t all information hereon i.s true and correct and I further
. ~~i.fY that any and all work performed shall be done in .accordance with the Ordinances of Lane County and the Laws of the St~\te of Oregon pertaining
; to the work described herein, and that NO OCCUPANCY will be made of any structu~e without the permission of the Building Division. I further certify
! that registracion with the B~ilder'? Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted
'hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. I HAVE READ AND CHECKED THIS
: APPLICATION THOROUGHLY.
Appl~catif~ /?~ //__ ~ J
PCrml.t ~~~. d /
DTwo Copies of Plans
. DTwo Copies of Plot Plans
OMcchanicaJ Checklist
o PlumbinCJ Checklist
OPlan Check Info Sheet
PROPOSED'\JSE' OF 'PR01;ERTY
~Residential []Industrial
D Conunercial Dpublic
I $
VALUE
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NUllmurn Setbacks: L, Jront ~ L, side interior
comment~:~/7d~~/~
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o FLOODPLAIN: In . flood haza.d area? ~o DYes,
o RURAL ADDRESSING: GRID COORDINATI:: N
~Sl\NITATION: S. 1. # B. P. #
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Installation Gall.on
Specifications: . Tank
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o Contractor
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Parcel
Size"~.?/~.
see
attached sheet.
Date: ;/~.g -//~
Date: I' D
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Date:
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Installation Record Issued? 0 Yes D No
o PLANS EXAMINATION:
Lineal Feet Maximum Depth
of Drainfield of Trenches
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Date: r;J1~rt ~
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Type'
Group
Use
Comments:
Date:
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CONSTRUCTION AUTHORIZED BY THIS PERMIT
4;;;J~/ Sq. Ft. ~~~7
~ YA4A~ J ~.
\~ONP l,~ .
$ 4.5:.4>-
FEES PAID BY: D~. . casy/
By: /'~./~7 /v
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( 0/./-" fA/!-, UllddJAi&Jjr/ '/1 rfkwJ r:j
P~~Y BUILDING OFFICIAL/DESIGNEE (per ORS 456.805(1)) - I DATE
COUNTY DEPARTMENT OF ENVIRON~mNTAL MANAGEMENT / 125 EAST EIGHTH AVENUE, EUGENE, OREGON 97401
Floodplain Fee
Subsurface Fees
Building Fee
S er/Storm Drain/Water
Fixtures
$
$ ~S. 1'0
$
$
$
$
$
$
Check Fee
State Surcharge
TOTAL FEE
Date:
LANE
C74-194
SEE REVERSE
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SETllACKSAND'OTHER.CONDiTlONS OF APPR L MUST BE STRICTLY OBSERV~D,.'.VIOLATlON CAN R(;SULT.IN REVOCATION Or- THIS PERMIT,
CHArlClN UNDER .PROVISIONS OF LANE COUNTY'S INFRACT.ION. ORDINANCE, AND/OR OTHER REt'lEDIES,:ALLoViED BY LAW.
. . '. . . . . ~ ' , .' . .' '
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\mEtl I{EAD.Y FOR, INSPECTION -CALL 687-4065. A' MIN.IMU~I :OF"AT LEAST 24 1l0UR.ADVANCE.NOTlCE FOR alSPECTION REQUEST MUST BE
GIVEN" ~iay.e .the]611bv/.inginfonnationready: Permit number, jo~ addre~s, type of inspection. when it will be ready,
your name aDd .phone num.ber,'.and a~y special directions to site.
3)
BUILDING. DIVISION:
REQU 1 RllU!~~nI ONS
1) .FOUNDATION INSPECTION:: To'be.made after trenche~ are"exca'va.te'd'.andfonns erected and when all materialS for the fOllr.ihltion
~r.e.deITver-edon tlfejob. : Where concrete from a 'central n'lixing ~lant (commonly terme.d "transit mixed") is to be USI~rl.
ilia ter i a 1 sneed Ilo.t lie: ~n: the. Job. , .
2) CONCRETE S.LAB..OR UNDE'R-FLOOR INSPECTION: To be made~fter all in-slab or under-floor buildin'l service eCluipment,.,
conduit, piptng acces,soriesang other ancillary eCluipmentitems are fn place but before.,a})y_ concrete is poured
or .floor sheathing in~ra:lled, includi.ng the subfl60r. .,'.~,. .... . . :. ....
FRAMING & INSULATfoNINS.PECTIOtis: To. be made after the roof.. all fr.aming.. f.ire bl~cking, ~nd. qraqing are in' placea~d '.
alL"pipes, fircpraces and chimneys and vents, are complete and all rough electrical and.plum'l:ifn'g are approved. All
wali insulation and vapor barrier are in place. ..
4) tATH AND/OR GYPSUM B.OARDINSPECTION: To be niade after'all l~thfhg',and gyp.sum board., interior and exterior, is in place
bu~~.b~fQre any p las teri ng i s appl,.i.~d ~Y' before gyp.sum board jO,i;rit,s, ahd. fas teners.are. t~p~d and. fi ni shed. _."
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5) FINAL Ii~SPECTION: To be made after:- the .building i~ .complete .and"b.efore Qccupanq.
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APPROVAL'REQUIRE"p. Nowork shall be aone on any. part of the building or structure tieyond. the .point .indicated .in each
successiv~ inspection ~lithout first obtaining the approval of the buildingoffici'\ll; .Suc,h apprpv(!l shall be,.given.'onl.y
. after an lnspection. shaH.have-been made-of each 'succ;e'ssive .ste.p in tne'construction.as indic'ilted by each of theinsp'ections
requi red. ,~' .. ' '. ...' : ....;. . . ,. . ... <.~:' '
.tiOIE:~ .(\1 1 bui Idi I1g, permits r~qui re inspections ,for. ihi work au:thori zed, such' as. butF" noel iJJiHed fo~" ,.
A. BLOCK WALL: .To be made after.reinforcing is in place, but before..any grout is poured, . This..inspection is..
. required for each bond beampour..T-here.wiH-'be no.approva'l 'until'tne'plumbing a'ndelectrical .inspections'
. ha ve been made and approved. , . ':, . " , . . .
B. WOOD Sr.OVE: To be made il:fter completion. of masonry'(i'f'aRplicablel andwh~n installation. is. complete.
fnstallatidnshall be >-j'n ,('jccord.1i)ce ,wi th .an a'pproved nationa"j iy recognjzed testing agency and the manu-
. facturer's installation. in.str:uctions. : .
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C.
110BILE HOME: An inspection .is requded aft.er the. mobile home is connected to an approved sewer or septic
sys.tem for:.; setback requirements"blocking, footing con,nection, tiedowns, Skirting,. and plumb.i~g'.
connecti,ons ~" ". .. .
". , - . .'" "... . , .' ,- .' -, . '" . >- . .
(I-) .Footings and piers to comply with Sta.te fou.ndalion'requiniments for mobile'.homes or.as recommended
by the manufacturer. . ;.., . ' ",. >'.
(2) Mobi.le home. minimum finish floor elevation .shalY be -cert.ifie~ when requir!"d by a f1oo~p1a.in
management letter: .. :
(3)t1obile .home.(iedowns; when required, and skirting. sh.al1 be .installed and ready for inspection
within at least 30 days after occupancy. lieqowns,and skirttng shall"be installed per: enclosure.
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,D. SWIMt11NG POOL:. Below grade when steel is in. place and,before":'concrete.is poured-.-..Abovegrade when pool
i.s ins tall ed. .', .. '., . ..- '. .. .
'APPROVED PLANS MUST BE ON THE JOB SITE ArALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIRE IF I-JORK DOES NOT .[lEG1N
WITHIN 180 DlIYS. OR IF WORK IS SU-SP.ENDED"OR ABANDONED FOR ~10RE T~AN' 180 DAYS'~'SUSPENSION ORREVOtAjfoN MAY OCCUR IF T/lIS
'PI~Ul:WASISSUED ON .THE BASIS OF INCQtlPlETE O~XRRONEOUS INFORMATION.
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ANYONE.PROCEEDING PAST THE P01~n OF .REQUIRED INSPECTIONS HILL DO SO AT HIS OWN RISK
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SUBSURFACE AND ~L TERNATlVE SEWAGE DISPOSAL SYSTEMS
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(1)
(2 )
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Permits shall be effective, for. one year from thed,ate ~f ,is.suance., .
Upon compl,etjng the construction for w~i,cA a',p;e.nni!has be_en~i;;s.u~,d t.h~p~~.~~ .hol~eT, shall notifY,the .
lJepartmentby subrilitting' th'e in'stallatlOn record form. The. Dep%tmrnt, sr_a:ll: lnspect ~he constructlon ~o
determi ne if it comp 1 i es wi th the ~ul es ~onta ~n~_d in this-Aty;i.s) (1)';,!" 'I;f t,~~~olJ.?tructlOn do~s comply ~/1.th' ,
such rules"the Department shall issue acertlflcate of.satlsfactory c?mpletlon to)he pernnt holder. If ~he
construction dpes not comply with such rules, the Department shall not.lfy the p~r~nt holder.and s.~all r~qu,lre
satfs'factory completion before issuing 'fhe certificate. . Fa,ilure to meet the rgqu.1reV1ent~ fo~ satlsfa~to.ry
completion within "a..reasona~le time con~~it~tes a violation of ORS 454.605 to ~54,745 ilndthls rule.
Setbac~s - Subsurface Sewaqe Disposal.
.\
.trom:
Interior property lines.
Edge of road right-of-way
nui lding foundation. ".'..
Wells. other water sources
Septic Tank
10'" .,
10'.
5''';
50',
Drilinfield
10'
10'
10'
, ..100'.
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CANCELLATION/REFUND I~UTHORIZATION PER~Tc;- 56~-cY /
NAME (PLEASE PRINT) ~#~y~d ~/ ~~ _ .
ADDRESS /7"'5',F ~~4 _d~_~~~~7'/P77
APPLICANT Jxi.&iR'C) . CONTRACTOR ( ) . #
REASON FOR CANCELLING PERMIT ~ fl"/~--4A;U ~~P /.4'..&7-<7/
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SIGNATURE
DATE
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FEES PAID FOR WASTE DISPOSAL SYSTEMS ( SITE INSPECTIONS AND/OR APPLICATIONS TO INSTALL THE SEPTIC
TANK AND DRAINFIELD) ARE ORDINARILY NONREFUNDABLE. SOME REFUND MAY BE ON THE BUILDING AND PLUMB-
ING PORTIONS ACCORDING TO THE AMOUNT OF THE PERMIT PROCESSED.
AUTHORIZATION FOR POSSIBLE REFUND:
% BUILDING PERMIT FEE $
. % MOBILE HOME FEE $
% PLUMBING PERMIT FEE $
% PLAN CHECK FEE $
% STATE SURCHARGE FEE $
.....
~
/ tJ D % SEPTIC DISPOSAL FEE $ .,.2~
% SITE INSPECTION FEE $
MINUS $25.00 FOR PROCESSING FEE $
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~5:.!!2-
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SIG~ATURE~~~~
..--- . ~ ._:IIl'
TOTAL M'OUNT TO BE REFUNDED $
DATE
TO: DEPARTMENT OF .FINANCE
BUILDING PERMIT REFUND $
STATE SURCHARGE REFUND $
SEPTIC DISPOSAL REFUND $ . ~?, ~
SITE INSPECTION REFUND $
24-08-24/ACCT 42120/PROG 021 Receipt #
24-08-24/ACCT 42124/PROG 021 Receipt #
24-08-24/ACCT 42133/PROr, 033 Receipt # ~~~~~.
24-08-24/ACCT 42134/PP.OG 031 Receipt #
TOTAL AMOUNT REFUNDED $ (~~!!!-
PLEASE ~__CtiECK ,PAYA~L~: ,/. .
NAME ~44~~p h/4<<~/_. L.' ? V ..
ADDRESS /<<ff:J~~ .~~~ /~Y: ~?/~e4~~~~__)
I /// DEPARMTMEtlT OF ENVI"~MENT~Nj\(~Er~ENT ~/
I COURTHOUSE/PUBLIC SERVI~~UILDING
1.25 EAST 8TH AVENUE, EUGENE, OREGON 97401
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. LtINE COU(!TY
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00 NO Ui\! ITS:. (-)0., NO ':-;'TOP I FS N() BL))GS: (-)(-) 'j
~n FT UNIT .COST VALUATION FFE DAY~
~'fl_~: 17033311.00500
NJ~:WBI...I)(; TYI::'E l.JSlt~: i:~ N(J BI)f~MS
coot APPL NO ACTION DESCPIPTION
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