HomeMy WebLinkAboutPermit Building 1982-6-25
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CONSTRUCTION/PLACEMENT j
PERM IT ';). (/Job
FOR OFFICE USE ONLY
COMPLETE THIS BLOCK. PLEASE USE BLACK INK AND PRINT.
TOI'iNSHIP / 7 RANGE tJ 3 SECTI'ON ~3 -~;!}t:J DOUT OF'
S.UBDIVISION/PARTITION,~if~~~~JP,1. e) L~~~~EL BLOC~} ~
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~~ON ~~ss ''7 ,~~. ~fl;~~?~~/CI~7~ ~:i~:~~::oP~~~~ustrial
ST~ ~_~u~ .ON PRUn,uY -. / V' /J /
(C~~ / / 0 Commercial Dpublic
~~~'- ~~~ Y7-?-f/-. ~. 'VAWE
,. #1lF BED t"?~ # S~R"IE f'OF'--;MP~S;E7Y.b W"ATER / _ )~/'//..~.O Prop07ed
7// /f /t//// ~~4') ~Xl.stl.ng
o S,MAME AN~ ADD~~~ "/" ~_ / .~5LO~N~2:4~1
~-#'~/~.~L ~~/ ~ .a::,.~. ;r~'l'YV'C/
lrt~d'S NAME A~~~~ ,- _ - - - _ ,
jcom~,~ e.44J"~.@Y~ -6 /57r~.
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certify that any and all work performed shall be done in accordance with the Ordinances of Lane County al~d the Laws of the St..atc of Ore{J':m per:laininq
to th'e work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify
that. registration with the Builder's Board is in full force and effect as required by ORS 701.055, "that if exempt the basis for exemption is noted
'75:::,""0, 00: ::::o:::~~/"""o'm'o"~o '00"'" '0 ==""0'. "" OM "",,, "n", ""~~~~"~"':
/ .. V t7' ~wner
:_ 1/~&//9~.i) t?;./~A.5 0 Cont:racto~
. - , NAME (please prlnt) . SIGNATURE DATE 0 Agent
APP1~catio~~/ J _
Perml. t # '/0 <-t
I '
[]Two Copies of Plans
. []TWO Copies of Plot Plans
[]MechanicalChecklist
[]Plumbing Checklist
[JPlan Check I~fo Sheet
: ~
e
Minimum Setbacks: CL,
,,/1}:'cMih?O ,-/./j#"'~h~.~,o/
fron~~/ L, side interior ~~
Parcel sizedz Y7'~
rear ~/
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Date:US'""0--8L ~
~ Yes, see attached sheet. Date: 5- -::;;; - BZ- ~
D
E
Date:
o PLANNING/ZONING:
comment::~ ':..-1~(
~~. " (\
~LO-O~P~.Qr~: In flood hazard area? D No
o RURAL ADDRESSING: GRID COORDINATE N
u;yS"P.NITATION: "S.,1. # B. P.
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Installation Record Issued? [] Yes [] No
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Ie rtpw sbch -v Date: ,"r~ I?- /~
Group M,-' Use Ol-\OP _ ~~ U~ aJLY
, ..'..i NO aoMJ..1E1i!.CJ.AL /
6.:::41::. PL.4.~ ~ ; I~DVS~L.. ~~;j~
B1e--A \ FO~~ Ora. wcDeJ:. PE:2M 11 U:::~...J
Date: (#/2.5h2, D
Lineal Feet
of Drainfield
, ~,
Maximum Depth
of Trenches
Installation
Specificati.ons:
Gallon
Tank
P~tD Strd.....~ ,~I
"("nit-k ~ 10/1- '\o/blrj Ii-o.M dn.-tn/,ne.s
Se~ SU Sfe-"1 J"I:-tf tJtJlIlSlru.ch;'l
[jj1>LANS EXAMINATION: Type~,~ ~
comments:~p ".AIN*
\-:rlti eIMtiOn
~. c=,' M5L
Comments:
/'
CONSTRUCTION AUTHORIZED BY THIS PERMIT
Plans Check Fee
$
$
$ ....:?' ~ ~
$
$
$ -
$ /3, ~.~
$' /' 11~
$ 4~ &4
FEES PAID ~Ck Ds~~
By: /f.N:.d) 74/f
/ //45/y?--
t6h5kf
,,- DATE
TOTAL FEE
~Ption
/ ~ //A/f
~//'f(r
~1/17 c?/b?:-~/
Sq. Ft.
Fixed Fee/
Unit Cost
Floodplain Fee
Subsurface Fees
Building Fee
Sewer/Storm Drain/Water
Plumbing Fixtures
Mechanical
State Surcharge
~P~c'lU~
TOTAL VALUATION
$
Date:
~
PERMIT APPROVED BY BUILDING OFFICIAL/DESIGNEE (per ORS 456.805(1))
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT / 125 EAST EIGHTH AVENUE, EUGENE, OREGON 97401
~
C74-194
SEE REVERSE
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REQUEST FOR EXTENSION OF CONSTRUCTION/PLACEMENT P1:RMIT':~'
~
TRS, TL: /7(,).3;(:g 6 6662 of'>
BUILDING PERMIT # %72 S /
NAME: ]30'1t.t?'5', J)01G6rAfC.O L. ....,
PHONE:
-;>,y/5' 71/9 L:. P ~ VI b tJ ~>V,.. Eut:;g-- /!/d--, /) d/?, 9 /' -'/ tJ I
7~7- 7L/db
ADDRESS:
REASON FOR EXTENSION OF PERMIT AND TIME NEEDED: r.~V /~ .4A'~ ~~ yL
- - -
A~ d~ /A: 4..;./ /RA/~ /,//~j" -7 /L rA~
. At.n~",V--.(l' ~-:'/~ ,-~~.L-4f ~2~~ /?n) 4A~ h~
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APPLICANT ,~ ~(~
SIGNATURE ,t~-1f'~.--?-/f"'J,~L,../
PERMIT ISSUANCE DATE O'~,:7-Y X"/
DA TE ~..A-'" / 7/ /77 "2.-
/
-------------------------------------------------------------------------------------
UILDING OFFICIAL
4- Z-1---g-7:-
DATE
BUILDING & SANITATION DivISION / ENVIRONMENTAL MANAGEMENT DEPARTMENT
125 EAST 8TH AVENUE / PUBlW SERVICE BUILDING / EUGENE, OP-~ON 97401 /
"
(503) 687-4061
'--!
('7-0~,,-z.,.3 .~Z.d-o,'
SEWAGE DISPOSAL SYSTEM RECORD '
to signature and submit both copies with application.
PERMIT NO. ~~~
PROPOSED
top part of form
INSTALLER'S NAME PROPERTY ADDRESS
';:zfM8~;/ -Ei~A=nAJc; Baldy View Lane
No~ Living Units Bedrooms ,Baths 6aseme'nt- Water Supply,.
Yes No Public 'Other-List
GG
Septic Tank:
Ft. frOm well Steel n ....::-.Conc~ete ~
f2A..~owr,D~ ~cr,I, ' D
Inside Dimensions: Ft. '
Len9th Width Diameter Depth
OWNER
NAME
Np., Com~artment_s I Ga 1. ~apaci ty' r '5"'00
Ti Ie Di.sposa] :,Field: - '
Distribution Box: Yes)< No
Other Distribution-Type'
MAILING
ADDRESS
r::ln:~ ~. 8 Jj'l ;::;
Route 10 Box 269A
Feet from
WEll
Lot Li ne
Front "Z...50' + Side "Z. c:;- RearIS""Oo'+
Ft. Between Fill ec '1 Fill er Depth Fill er Bel CM
Lines .( 0 Type I~-o Above T i Ie Z in. Tile (h in.
Foundation
(
~~8
Eugene Oreqon
Length of Lines-Ft. Trench Total Sq.
1~~-21~e> 3 Jo9+. 5. 6. Wi dthZ+. Ft. <;;:'c>o
Plot Plan (see instructions):
R E eEl V ED
gy ,..-.:.-............
APR 111977--
bANE COUNTY
~NVIRgNM~NTAL MGMT.
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Date 4-1 ;f3 f?'? S i q!lature A( ~ // o-t ' ov./k-
/ l.-' CERTIFICATE OF SATISFACTORY COMPLETION .' 1"--J' "
For Sanitarian Use Only: , , " ,Date: -,-/2.-77,
In accordance with 1973 Oregon Laws Chapter 835, Section 214 this certificate is issued '
as evidence of satisfactory completion ,of a subsurface sewage disposal system'at the above
-1 oca~i n.' ,', , , "
Approved: System Installation conforms toc. urrent standards
" Disapproved: ',Does not conform to current ,standards
Remarks: '
\
Z1?
STAO.
JF OREGON DEPARTMENT OF
d'~_
" Sarii tari an' s- ~ i gnat~
. "'JE COUNTY , U'
ENV I RON,... ,/AL 'QUALITY
'!I
C55-11
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