HomeMy WebLinkAboutPermit Septic Tank 1984-7-3
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SJBDIVISION/PARTITION (if applicable) I LOT/PARCEL I BLOCK
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I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATIO FOR PERMIT, and do hereby certify that all information hereon is true and correct, and that I
have the following legal interest in the property; owner of record; []contract purchaseri[]authorized agent with evidence of authority attached.
I f~rther certify that any and all work performed sha done in accordance with the Ordinances of Lane County and the Laws of the State of Oregon
pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I fur-
ther certlfy that registratlon with the Builder's Board is in full force and effect as required by ORS 701.055, th if exempt the basis for exemptlon
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FOR OFFICE USE ONLY
Appl~cation//~/ ~ t?~l'
Permlt # / / / i...J -0 ~
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D Two Copies of plans
D Three Copies of Plot Plans
. DMech/Plumbing Checklist
DLegal Interest Document
Dplan Check Info Sheet
PROPOSED USE OF PROPERTY
f)j::teside.ntial D Industrial
READ THIS SECTION CAREFULLY. YO~R J1U;?HORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS~
o PLANNING/ZONING: Zone 4//// parti tion # Parcel # Parcel Size
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o FLOODPLAIN:
In flood hazard area? D No 0 Yes, SEE ATTACHED SHEET.
Date:
~ANITATION: S. 1. #
~'Installation
Specifications:
Gallon
Tank
Lineal Feet
of Drainfield
Installation Record Issued? DYes D No
Maximum Depth
of Trenches
B. P. #
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o PLANS EXAMINATION: Type
Group
Use
COMHENTS:
Date:
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TOTAL VALUATION $
CONSTRUCTION AUTHORIZED BY THIS PERMIT
DEQ Surcharge
$
$
$
$
$
$
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,,~. ~ J5ERMIT APPRO~D'-wr""BUI~i5" OFFICIAL/DESIGNEE (per ORS 456,805 (1)) DATE .
LANE COUNTY DEP. MENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061, C 14- 25
25 EAST 8TH AVENUE, EUGENE, OREGON 97401
Fixed Fee/
Unit Cost
Floodplain Fee
Subsurface Fees
Building Eee
M2ch/Plmbg Fee
plans Check Fee
State Surcharge
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TOTAL FEE
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SEE REVERSE FOR INSPECTION INFORMATION
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SETBACKS AND 01'HER CONDITIqNS OF APPROVAL .MUST BE STRICTLY OBSERVED. VIOLATI0N, CAN' RESULT "IN' REVO-
CATION OF THIS PERMIT, CITATION UNDER PROVISIO~S OF"LA~E COUNTY'S INFRACTION ORDINANCE, AND/OR OTHER
REMEDIE~ ALLOWED BY LAW. . , - -, ;';, " ,_,~.:.,
WHEN' READY FOR INSPECTION, \:ALL 687-4065.' 'A !:1:INIMUM OF AT "LEAST~ 24 HOURS:, ADVANCE 'NOTICE FOR INSPEC-'
TION REQl,IESTS MUST BE GIVEN. Have the fo'llawing' fnformation 'ready:' peirm{t n-;Jmber',''"job address; . type
. of inspection.,' when it w,~ll. be ready ,your name and pho~e number, and any special direct~()ns .to site.
BUILDING DIVISION:
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REQUIRED INSPECTIONS:
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1. Founda tion Inspection: To be made after-trenches 'are excava ted:- and. forms' erected -and when 'al-l ':'"
materials for the foundation,are. 'delivered on the job. Wher~' conc,d;te"f~om >a'cent~'~1'~ixing
p,la?t (commonly_ .termed "tran~i.t,,.rl\ix~d:? ,is to~' b,e~sed; mat:eria!~ :~eed" ~;~t. ~e...c;m~ !-he 25'b:. ,,:,,-
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2.':Concre.te Slab or'UI}der'-Floor Inspection: To be'made,after al1in-sl'ab.,~r""~nder-flo.o-E building
I. se'r...vice equipment', condu'i t, - piping accesso"r.ies'I and"\b.t:her ancillary "'equi~prneh.t .i terns .ar'e, in,
place but before any concrete is poured or floor phea thing' ins talled, including the"s'i.i1:,f lo'or.
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3'. .Framing'& Insulation-Inspectt'o'ns: 'To be made after the'roo'f', a'll- fram'thg~'fire'b:tocking., 'a:nd'
-.. brac.ing.are in place and all pipes, fireplaces,. chimney~, ..and vents .are 'complete C;lna a~l ~r.9lJ:gh
electrical and plumbing are apprs>yed. All. wA1J, inl?ulati:c;m ,a,i1d, v?,pqr qarrtep ,aF"e. ir};'\P:j.ace.: C'." ...,
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4. ,Lath and/or Gypsum Board Inspection: To be made after all-lathing:-and gypsurii,.board, ,itlterior '"
- '~"-and, exterIOr" is in place but before any plastering is applied and oefore gy,psum:"boara j6in-cs' ,
and fasteners are ~aped and finished.
5. Final Inspection:
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To be made' 'after the..buil~li~g' is comp~.ej;.e'''',:tnd, before ?ccup,ancy~,
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APPROVAL REQUIRED. ~owork,shall be. done on any. part ot tre.b~11d1ng or structure beY9nd ,~h~ po~nt
indicated in ',each successive inspection withou,t'.first ,obtaining. the' ,approval of ,the building ,official.
Such approval shall be given only after an inspection 'shall have been made of each successive step
in.the.construction'as indicated by ea~h of the iqspections required. '"
, NOTE: ,All building. perm.its require in~pections for ,tl].e ,work autch,or~z~d'" s~ch as' btit 'n-,?~ .1.iini,tced te>.:
'f... Block Wall: ,To be rrtaq.~ aitoer'~einfor9ing is in place, but before any grout is pourep. This
inspection is required for each.' bond 'beam pour; There wi 11 be 11O' approval un ti 1, the plumbing
and electrical inspectl.ons have' been' made -and' approved.., '
B". WO'od Stove: . To be made .after completion of masonry (if ap'plicable) and when installation is
~complete. Installation shall be in accordance with an approved, nationally recognized testing
agency and the m~nufacturer'9 iqstallation.instructions.
C.' Mobiie Home: An'inspection is. required a:fter thernobile home is connected to an approved
sewer or septic sys tem'~ f.o~ '_~'e):b.a,ck 'requiremen t'~, blocking,' footing ,.cpI}I:I,e~~_ioD, .'t_ieq.o.~ms',
skirting, and plum~ing connections.
-1. Footings and piers to comply' wi'th State foundation requirements' for' mobile homes or as
recomniended by.th~ manufacturer. . .
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2. Mobile. home minimum finish floor elevation shall be certified when required by a flood-
'. plain management letter. .,
3. Mobile home tiedowns, when required,. and skirting shall be installed and ready for inspec-
tion within at least 30 days after occupancy. Tiedowns and'skirtingshall be installed
-p'e~ enclo~uJ:"e., '.:, . . .~, . ~ ' ,
D. Swimming Pool: Below grade when stee~, is in ,place and before concrete, is poured . Above . grade.
when pool 1S installed.
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APPROVED PL~NS, !'1UST B~ ON THE JOB "'SITE AT ALL TIMES DURING ,WORKING HOURS.. THIS PERM~-r:.'.. WILL EXPIRE
IF W6R~ DOES' NOT BEGIN, WITHIN 180~DAYS,-OR IF'Wp~K'IS SUSPENDED'OR' ABANDONEb{F~R MORE THAN 1?0 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERM~T' WAS ISSUED.ON THE BASIS, OF INCOMPLETE OR ERRONEOUS
INFORMATION. . " . -." ._,,=-,~ ." t~..,-"'.2"""4'" _ . t;. " _ . '- ~::,.> _,..). f .. -} \ j' __
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~ _:"?\NYONE PROC.E~Dl"NG'.PAST; THE POINT 0:( RE,QUIREQ .INSPECTIONS WILL .DOElO A'J' THEIR OWN RI,SK.. ,
SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
1. Permits shall be effective for one year from the date of issuance,:' '. ,_
2. Upon com'pleting U~; c~nstruct'ion 'for 'which' ~ .p~rmi t has .been issued, the permit holder shall
notify the ~ane Gounty. Depa:l:tment, of Planning_aI}d Community Development by submitting the
installation record form. The Department shall inspect:the constructioq to determine if it.
complies ~it;h _,tl1erules' contained iI}. this ,division. If the 90nstruction does comply with such.
rules i the Department shall i,ssue. a certificate of .satisfactory., completion :to ,.the permi ttI:101der..
If the construction does not comply with s~ch rules, the Department shall.notify the permit
holder and shall require- s.i,!tisfactory C:oI!lPletion bet6ie"ls_suing th.~ ce~tJ-f.i<<a~e'. Failure to .
meet the,'requirements for satisfactory completion within a reasonable time constitutes a vio-
,.lation of ORS 454.605 'to 454.745: and this rule.
Setbacks - Subsurface, Sewage Disposal
. Septic Tank
From: Interior property' lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells; oth~k water sources 50'
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Drairlfield
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Irlflt: county
ACTIVITY INFORMATION SHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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PERSON MAKING REQUEST
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MA I LING ADDRESS
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~ CITY STATE
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ZIP CODE
B, J,' YtI#,$~~EL
PROPERTY OWNER
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MAILING ADDRESS,
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CITY / STATE' ZIP CODE
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BUSINESS TELEPHONE # HOME TELEPHONE #
,l/8'1-<6~~ () .
BUSINESS TELEPHONE #
7/,/7 / ~ t/ 2/
HOME TELEPHONE #
2. PROPERTY ADDRESS
(IF DIFFERENT fROM MAILING ADDRESS)
3 MAP & PARCEL NUMBER (from tax maps in Department of Assessment and Taxation
(REQUIRED INFORMATION) or from. tax statement)
17 63' ;:)../?" 4 02~O~~
TOWNSHIP -RANGE SECtI-cffi . TAX LOT(S) .OR PARCEL # ZONING
TOWNSHIP RANGE SECTION
TAX' LOTtS) OR PARCEL #
ZONING
. TOWNSHIP ~ANGE SECTION
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:.
4 SUBDIVISION (if applicable)
TAX LOT(S) OR PARCEL #
ZONING
LOT
ACRES
BLOCK
5 REQUEST (state exactly what you plan to' do)
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6 DIRECTIONS TO SITE: 8e..TWe~/I/ &Ut/t'Nl'_ 4~ 8~r:.c/' nr IJt:>/!/k/J/a,.v Be... 1/
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** FOR STAFF USE ONLY;**
NUMBER
DATE
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ZONE/LAND USE:
BY: DATE:
TIME IN:
OUT:
LAND MANAGEMENT DIVISION / 125 E. 8th AVE.. EUGENE., OR 97401 / 687-4061
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Plat
Subdivision
Lot
'Plan
Block
C74-150
Vicinity Map
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Permit II
Permit II
Permit II
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