HomeMy WebLinkAboutPermit Septic Tank 1987-12-21
t1~~ -I.JL/~a"ne~r~e-
~ - County Authorization for:
.........
FOR OFFICE USE ONLY
SEPTIC INSPECTION FOR LOAN REVIEW
Appl~cation/~/ ~c> G
Perm~t # ~(O JO - t1 7
- TOWt,SHIP
17
RAr-lGE
03
SECTION
23.3.4
TAX LOT
4500
DOUT OF
?ROrOSED USE OF PROPERTY
KJ Pe.sidential D Industrial
o Ce,n1ffiercial D Public.
S~BDIVISION/PARTITION (if applicable)
LOT/PM',U::'
BLOCK
LOCATION ADDRESS
STREET
CI','Y
Springfield, OR
ZIP
97477
345 Blackstone St.
STRUCTURES CURRENTLY ON PROPERTY
SFD
DIRECTIONS TO SITE
Go to 5th and Hayden Bridge Rd; North 2 blocks and make left turn.
Approx 2 blocks
down Blackstone.
u~SCRIPTION OF PROPOSED WORK - BE SPECIFIC
DECLARED SVALUE
SEPTIC INSPECTION FOR LOAN REVIEW
= OF BEDROOMS # OF STORIES # OF EMPLOYEeS
4 I
!-IATER SUPPLY
~ Proposed
Xl Existing
TELEPHONE NUMBER
747-3387
, o;mER 0 S NAME AND ADDRESS
Q",~"'''tr...~-~I~ Parma & Sunita Prasad 345 Blackstone St. Springfield, OR
CONTRACTOR'S NAME AND OSR #
TELEPHONE NUMBER
726-8243
, P:::Rl-lIT TO BE MAILED TO (NAME AND ADDRESS)
Tr:LJO.l'HONE NUMBER'
Same
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION FOR PERMI'.!', dnd do tE~re]),/ cettify t.hat all infol-mation hereon is true and correct, and that I
have the following legal interest in the property: Downer of recol-di 0 crA,tr-dCt. purchaser; ~authorized agent.
I f:.:.rther certify that any and all work performed shall be done in aCCOl.Jant.;(".: '..d. t:.h U::'8 Or-dlnance.::; of Lane County and the Laws of the State of Oregon
-pertaining to the work described herein, and that NO OCCUPANCY ....Till be mane of ar.y Sr.];'llcture '.....ithout the permission of the Building Division. I fur-
ther certify that registration with the Builder's Board is in full force ond effect as re~uired 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.
Albert D. Gaines
NAME (please print)
SIGNATURE
DATE
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION qAS BEEN BASED ON THE FOLLOWING CONDITIONS:
[] PLANNING/ZONING:
Zone
Partition #
Parcel II
Parcel Size
Minimum Setbacks:
C
L, front
eL, side
interior
rear
COMMENTS:
SEPTIC INSPECTION FOR LOAN - NO SPECIAL PLANNING ACTION REQUIRED
12-17-87
Date:
(~
o SANITATION:
S. 1. #
Installation Record Issued? 0 Yes 0 No
Maximum Depth
:!!~~41i'~~~~f:;1~ ~ A-
-" ~ ~~ , ^ . _ Lte: /,.2-2/-/7 ~
Type C GraUl> Use
B. P. #
Installation
Specifications:
CO~IHENTS : f\J~ {J /'
~N'
COMHENTS:
Gallon
Lineal Feet
Dale:
n
~!'Bmci.-< NEf (00< ONE 456.aO","} /.2- ~2.~;://?
LANE COUNTY DEPARTME PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,
125 EftI 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION C14-2'iRR4-
~
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SETBI,CKS ,;.;",0 Q':';!::R CC':;:JIT.::0::'; OF APPRO'J.\L :>:C:=:;':' BE STRIC:-:"''.:' O~SER\'ED. \'IOLA':'IO:-J c.;;:; R::SlJLi IN REVQ-
C~~IO:J OF ':'!{IS Il~R~!7, CI':'~Tl=:; L'~DSR PROVISIO~S OF ~A~E ~J~::7Y'J l~FRACTIO~ O~D::;A~CE, A~D/OR OTliER
REMEDIES ALLOWED BY LAW.
~";HEN RE.:":))" FOR I~~SPCC7IO:-J, c..:;:...:.. 687-4fJ65. i\ :>lI);'I:.;L':.; SF ;;:: L::;\ST 2~ 1I0t'RS ADV:\::':':E :~O':':::CF. FOR INSPEC-
;::::O:~ RE~~ESTS :.::...,ST bT:----:;IVE:;--=--~i3.,;c the-{ollo',.;ing in:8:!:'"~3. t lon r-c3dy: rcrmi t number, ~ob aJdress, type
of inspection, when ~t w~ll te ready, your n~mc and ptonc nu~ber, and any special jlrcctions to site.
BUILDI~G DIVISIO~:
RF.QUIRE~ I~SPECTIO~S:
1. Foundation lnspcctlon: To be made after trenches are excavated and forms erected and ~hen all
~atcr1als for the to~njation are Jclivcrcd on the Job. ~hcrc concrete from a central mixing
plant (commonly termed "transit mixed") is to be used, materials need not be on the job.
2. Concrete Slab or Cnder-?loor Insnection: To be made a:ter all in-slab or under-floor building
servi~e e~uipment, c~nau1t, piping acccssorles, and other ancillary equipment items are in
place but before any concrete is poured or floor sheathing installed, including the subfloor.
3. Framinq & Insulation Inspections: To be made after the roof, all framing, fire blocking, and
bracing are in ~ldce a~d all ?ipes, fireplaces, chimneys, and vents are complete and all rough
electrical and plumbing are approv'ed. All wall insulation anc,f vapor barrier are in place.
4. Lath and/or Gvpsum Board Inspection: To be made after all lathing and gypsum board, ;nterior
and exterior, lS in place but before any plastering is applied and before gypsum board joints
and fasteners are taped and finished.
5. Final Inspection: To be made after the building is complete and before occupancy.
APPROVAL REQUIRED. ~o work shall be done on any part of the building or structure beyond the point
indicated in each successive inspection without 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 each of the inspections required.
NOTE: All building permits require inspections for the work authorized, such as but not limited to:
A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. This
inspection is required for each bond beam pour. There will be no approval until the plumbing
and electrical inspections have been made and approved.
B. Wood Stove: To be made after completion of masonrv (if applicable) and when installation is
complete. Installatlon shall be in accordance with an approved, nationally recognized testing
agency and the manufacturer's installation instructions.
C. Nobile Home: An inspection is required after the mobile home is connected to an approved
sewer or septic system for setback requirements, blocking, footing connection, tiedowns,
skirting, and plumbing connections.
1. Footings and piers to comply with State foundation requirements for mobile homes or as
recommended by the manufacturer.
2. Xobile home minimum finish floor elevation shall be certified when required by a flood-
plain management letter.
3. ~1obile home tiedowns, when required, and skirting shall be installed and ready for inspec-
tion within at least 30 days after occupancy. Tiedowns and skirting shall be installed
per enclosure.
D. Swimminq Pool: Below grade when steel is in place and before concrete is poured. Above grade
when pool-rs-installed.
APPROVED PLA~S ~UST BE O~ THE JOB SITE AT ALL TI~ES DCRI~G WORKI~G HOURS. ~HIS PE~~IT WILL EXPIRE
IF WORK OOES NOT BEGI~ WITHIN 180 DAYS, OR IF WORK IS SCSPE~DED OR ABA~DONED FOR ~lORE THAN 180 DAYS.
SUSPENSION OR REVOCATIO~ :-lAY OCCUR IF THIS PERNIT \'IAS ISSUED O~ THE BASIS OF INCO~PLCTE OR ERRONEOUS
INFORMATION.
A~y'ONE PROCEEDING PAST THE POI::T or REQUIRED INSPECTIO~lS WILL DO SO AT THEIR OWN RISK.
SCBSURFACE A~D ALTER~ATIVE SEWAGE DISPOSAL SYSTEMS:
1. Permits shall be effective for one year from the date of issuance.
2. Upon completing the co~struction for which a permit has been issued, the permit holder shall
notify the Lane County Department of Planning and Community Development by submitting the
installation record form. 7hc Department shall inspect the construction to determine if it
complies with the rules contalned in this division. If the construction does comply with such
rules, the Dep..1rtrr.ent shall issue a cert1ficatc of satisfactory completion to the permit; ::older.
If the construction docs not comply with such rules, the Dcp.J.rtment shall notify the pp.rmit
holder and shall rcqu1re satlsfactory completion before issuinq the ccrtlfl~~te. F..1ilure to
~eet the rcq~irements for sati~fdctory completion ~lthin a reasonable time constitutes a vio-
ldtiorl of QRS 454.605 to 454.745 and thlS rule.
Setb3cks - Subsurface ~~0,C Dlsposal
E'rom: InterIor property llnes
Edge O~ rood rl--.::.t-of-\.JdY
RUllulnq founclati~n
~ells, other ~ater 30urces
:0'
Drainfield
10 '
10 .
Septic Tank
10'
5'
SO'
lO I
100'
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ACTI\_ fV INFORMA1:'IONvtlEE'T
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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PERSON MAKING REQUEST
PROPERTY OWNER..../
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MAILING ADDRESS
MAILING ADDHESS
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CITY
STATE
ZIP CODE
CITY
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STATE
ZIP CODE
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BUSINES~ TELEPHQNE #
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HOME TELEPHONE #
3 MAP &. PARCEll... NUMBER
(REQUIRED INFORMATION)
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(from tax aps in Department of Assessment and Taxation!
or from, tel statelrfent)' .
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TOWNSHIP RANGE SECTION " TAX LOT(S) OR PARCEL #
ZONING
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TA'X LOT(S) OR PARCEL # ZONING
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TAX LOTi\S) OR PARCEL # ZONING
ACRES
LOT BLOCK
TOWNSHIP RANGE SECTfON
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TOWNSHIP RANGE $'ECTION
TOTAL CONTIGUOUS PROPERTY IN SAME OW~RSHIP:
4 SUBDIVISION (if applicable) ~
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5 REQUEST (state exactly what you p1?fi to do) .
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6 DIRECTIONS TO S-ITE:
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** FOR STAFF USE ONLY **
ZONE/LAND USE:
14-33
LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-40'61
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ACTIVITY INFORMA TION SHEET
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l ANn M^Nl\r;r Mr NT O'vr<;'()N
Or"'..'........, ..1 ""hl.-: ..,..,'....1
Please com~lete all Items above dotted line
FILLING OUT * LINES WILL GET YOU INFORMATION ONLY
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*DATEj2-_1 /0' / 67
* PERSON .' /. 7J /' ACTUAL ~ r J) ,
~~I~~ST /TL8re.-r v. (-rA/A-lp<; 6~O:l:TY M~/!r? ;I- '~t//JIPi 7e/l5r1D
ADDRESS' -:??Z3C;- ___~c:::>. ;t,?f I"ST: ADDRESS . ~c/:;;- ,~L-..qc/0S-..72'A/~ .
CITY '5jP./'/.) . STATE OrZIP f;?fJ7/,c,TY ~/~I? ' STATEL2L ZIP 77Y:::7
TELEPHONE (BUS) 7Y7-33?7 (HOMEl ?V - ;2tJSZJ - TELEPHodE (BUS) 7~-R.:z~3 (HOME) -7'fr -5/..2<:5
*PROPERTY ADDRESS 31'S- 3LAU<"STd~E
OR
MAP & PARCEL NUMBER (Found on tax maps in the Assessment & Taxation Dept.)
STAFF WILL 9fTERMLNE
/7 03 233'/ ).Cnz;' ZLGz9-~~/
Township Range Section Tax Lot Zoned'" Flood PIa#;
Township Range Section Tax Lot Zoned Flood Plain
Township Range Section Tax Lot Zoned Flood Plain
~""..':". .- .......'..,. . ". -",~
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ACRES
*REQUEST(describe what you want to do)
//E?4pt"~7r~ 4~
MED
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A, SEiPT/C
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Dire,c)ions to site ____bt? ~
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....................Staff Use On~....................
Comments:
i Land Management Division, Public Works Department 125 E. 8th Ave., Eugene, OR 97401 phone 687-4061