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HomeMy WebLinkAboutPermit Septic Tank 1986-9-19 ~ i'- ~ J-F/'~ ~1r \2.0 \JJTO ~,-r;~h~' ffiount "~oGation for: ~~~r--; _YJ"/h--/?7 ~;( c: z Th~ OF LOT/PARCEL . BL6cK ~. FOR OFFICE USE ONLY APPl~cation,/I~~~, ~~~. Perm~t # ~~ 5 --~~ c;.;;.? . mWNSHIP / 7 AANGE (/ S SJBDIVISION/PARTITION (if applicable) PROPOSED USE OF PROPERTY ~esidential 0 Industr ial ,VD~ercial 0 Public LOC~?~S~;?677 G~6'Y ,- .J~;;;~~~ . 9/,?/7/ ,~~c:.;", CO""NT", ON">'O",'T' S . - /' ~ . ~ -' -~) /~i1~~f~~ ~~~/ ~~?/--Y~ v~/7?t< j'/' ~ (/-7~/7~~ ~~~:?~ ~/~~41/ I /t?pr~=' ;~~/bYV/ ~A~J~~~~~- ~/ ( -;)ESC~ OF PROPOSED WORK/ BE SPECIFIC ~. (--: - DECLARED $ VALUE /~7~ ~.::~~.~~/~ "- ~~///~~----.J~Pr--~~ =. OF BEDROOMS ~/ # O#/~. r # OF ~ \-IATER SUPPLY ~~~, ~~~~~~~: , O;'~AME fiND ADDRESS _ ~./ 2:: ~', .-- -, . ~ T'L,,,ON,,-.i,,,,,,, ///4\/~ r/?~/~~ '---"~~A-A ;~~7~c?~ ,~~~ ~h /' '.~-e~~ t>:::ffi.lIT ~ g~E MAILED ~~ 'ADDRE~S~ . L TELEPHONE NUMBE,R S2-///~ /~ ~~_ )~..L~ . I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION "'OR PERMIT. 'and do hereby ce rtlfy that all information hereon is true and correct, and that I have the following legal interest in th~ property~er of record; 0 contr,act. pllrchaser; Dautho~ized agent. .' I f::rther certify that any and all work performed-~l'i")be 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 an.y st.rllcture without the perrniss~on of t:-he .Building Division. I fur- ther certify that registration with the Builder,Is Board is in, full force and effect. ,as reC;uired by ORS 701.055,. tnat if exempt' the basis for exemption ;:~~;~~;:~~o m '0 Ljr~' 'jfl~~t 00 m"""oo,: ~ kk ,,~ . -, ~<o"'. pho<) f) f "'AA"~. / / / "re . ~ANITATION: S._ 1. # B. P. # ~ "'Installation _ J Gallon'" Lineal Feet ' Specifications: ~ 'Tank J, ' :J... f'r() of Drainfield ' r.iJ"J;;:~~. ';;,1'6 ~L ~"a,;L;f~.~ 6 PLANS1 EXAMI~ ION: Type Group Use READ THIS SECTION CAREFULLY. YOU~THORIZATION gAS BEEN BASED ON THE FOLLOWING CONDITIONS! . ~~ o PLANNING/ZONING: Zone *(Y~artitiOn # Parcel # Parcel Size-;;;;'~ . C ... / . C . , ....' .---:? ,. /" Minimum Setbacks: ' L, front / L, s~de ./? ,:Lnter:Lor ~./ rear Cm\lENTS://Zt ~~~/h' ~/4/'//~~~~ /..,- _/.-r /~ ?/" r -. '. Da~e: c ~~~,__ ., ,;/ /' - Installation Recor~ Issued? 0 Yes 0 No {.'/ Maximum Depth ~ ~ ' of Trenches ~ $ -;;fLu dtL.td~ .(j'1-17-f{ ~ Date: COMHENTS: Date: o . . ~) ? PERMIT APPROVE _ !?~s: cry! /C ING'OFFICIAL/DESIGNEE (per ORS 456.805(1)) DATE PARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 SEE REVERSE FOR INSPECTION INFORMATION f' 1/. _,?" gQ,l. ACTIVITY INFORMA l"IO!~~H EE~r - ..1...... . COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED! .".".-,.,-. ""..-,,, . .. .~.,. ",,".'. p, .' ....,. .,,,..,, '., " . r~J1x \ ~Elfl~R~~rREQUEST . I ~q 0 At;PG~ ~i ~ . MAILING ADDRESS j S P I'Uh\A ~~~ (~rL q 1 <f-17 1 . CUV STATE ZIP CO Dr 1}(O '1/1,5'3 ' 7lf1 ,8 P0 <6 1 BUSINESS TELEPHONE # HOME TELEPHONE # I I ~A ~ 2 PROPERTY ADDRESS _ '/fil (Yl/b . (IF DIFFERENT FROM MAILING ADDRESS) ?)A!ltb PROPERTY OWNER 6AME MAILING ADDRESS gA-wJ3 CITY STATE ZIP CODE ~rJ...Q- BUSINESS TELEPHONE # .5IJi'VLG HOME TELEPHONE # , ! 3 MAP &. PARCEL. NUMBER. (REQUIRED INFORMATION). . (from tax maps in Department of Assessment and Taxation' or from tax statement) /703 "3<(,).). '.~ . 00600 TOWNSHIP RANGE SECTION TAX LOT{S) OR PARCEL # ZONING TOWNSHIp. RANGE SECTION TAX LOT(S) OR PARCEL # ZONING TOWNSHIP RANGE SECTION TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: TAX LOT(S) OR PARCEL # ZONING i~ / L- ACRES i 4 SUBDIVISION (if applicable) 5 REQUEST (st"ate exactly what you plan to do) ~jJ,f9~~' ~ ~ ~tLJ Oh/ll~f;.Q)J . I LOT BLOCK ~JC/ ~ CtM;/L ",L ,. (l 1.lot I ({,\ f,tJ f 1\ \...UV\I\. 'i()' i 0,-,,-1 " 6 DIRE cn ONS TO SITE: 'F;;, rJY\. (rv.,jJ)JI/'rV,-Al 4th at ~'r'e<< I 1 .1 ~ S~,~ A<;r)/l,^- /' .WMt~ '1 . ** FOR STAFF USE ONLY ** ZONE/LAND USE: 14-33 ~ LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-40'61 TRS, TL PI 01: Subdivision Lot . C74-150 Plan Block j': ,'- ,-- ,- ,--" " \ '../. , . O),TE BY Vicinity Map Job Location Permit fl Permit fl Permit fj (Address) For For For '610 {J.~(r41~ St, 'k AClGb - SfuAR-E Lt1T ~\ () N Permit fl Permit fl Permit II .f~<2 0A/Lb5rJ AtZ-E4 _ pdt ~,0( l~j/_ / / 1.>, -- n --~ ,-- -~~. --'~/ , , ;. " -' rFi\)(f. 1" j i' I~~G ~ / ~'A!Jl :?,.,/ -' 0/ 'ill" ~. . ) /~ ~ ~ \1- ('-~- ' , ),buSG ASPEN sr. r--=-, ...:./..:, '--,. . . ~ ~Gf: (W€u. SI1t;[) !J ? / c- ) ~' J / ]}Mt tJ eJ For For For