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Home My WebLink AboutSEP1974-00247` 0i5e0v& y ,6a y lel i lls, rwe-, 903 E, Caroline DV.V�OLYMPIC HEALTH DISTRICT Permit No. (�30 Port Angeles--��' SEWAGE DISPOSAL PERMIT APPLICATION Submit in Duplicate Builder .Court House Port Townsend Date_ 7 5�—` OWNER SSC � .,\\S�� DRESS� c� �a S 1 a - v DIRECTIONS FOR LOCATING`SITEQi 4 APPLICATION IS H REBY MADE TO: INSTALL N°U SYSTEM AIR EXISTING 98TEM B ILDING N0 OF BEDROOMS T I SITE SIZAI 0 INSTALLER DRAINFIELD LENGTH arJ ' IIDTH 3 . DEPTH --)p #LINES SEPTIC TANK SIZE:, Z, DRAY A DETAILED PLOT PLAN BELOVI. SEE INSTRUCTIONS. SOIL TYPE 0 q j 5` a r S- C' C c )ING OR SE"A,GE DISPOSAL PLANS, LO i PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. DATE ,OF INSTALLATION SIGNATURE OF -UP ANT A� _ DATE 725 INSPECTED BY \ DATE0 SANITARIAN'S C011MENTS: 5q- Fi�,�� U3 I CERTIFY THAT THIS SYSTEM '.,AS INSTALLED IN THE MANNER APPROVED BY THE D HEALTH DEAPRTMI;NT AAS -- INSfiALLERS NAME (J\ Map Output HTML Viewer Page 1 of 1 Legend p;," JC_Rnatb GM FP Stream ClaselftaNen Ni F. Vkh HARM N.N.1f b140" a� Ny-Nan..i�Na4iiabPwnnY1 Ns- 11604wh NMNIM•SmnM yf ♦ S. hvaM1wwd &wee OW Streams Ty" 9 fA/ TV.5 Ty" .1 /.I T". a I. Typ2 l� Ty" 1 on - 2009 Aerial Photos OR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained Fthis map is limited by the method and accuracy of its collection. Mon Nov 22 10:47:30 2010 http://gisserverlservleticom.esri,esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=... 11/22/2010 PLEASE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT This form is you receipt when Stamped PLEASE SEE REVERSE by cashier. CHAPTER 82.45 RCW - CHAPTER 458-61 WAC For Use at County Treasurer's Office (Use Form No. 84-0001B for Reporting Transfers of Controlling Interest of Entity Ownership to the Department of Retemu) THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS 1-7 ARE FULLY COMPLETED Elsie E. Andrew, Trustee of John Name James Gilmore Andrew Name G. Andre3vs a 283234 Hi LD —hway 10 -fa 17 �9�,-Go—rdiner rte d Street street City/State/Zip Port Townspnei,W.A Q 8 3 6 8 O City/State/Zip - PARCEL NUMBERSX P ALL TAA ADDRESS TO SEND ALL PROPERTY TAX RELATED CORRESPONDENCE A t.. Name Same as boxes 9512=2113-�15 StreetX$�$St7�i;xbdi�bta¢a}tX�@� x$�EitX��otFiBstt�l n LEGAL DESCRIPTION OF PROPERTY SITUATED IN O UNINCORPORATED COUNTY ❑ OR IN CITY OF Street Address (if property Is improved); 252872 H%.ghway 101, Port Townsend, WA 98368 Portion of the James Tucker Donation Claim40 in Sections 24 and 25, Township 29 North, Range 2 West, W.M., in Jefferson County, WA Is this property currently: YES NO Classified or designated as forest land? ❑ ❑ Chapter 84.33 RCW Classified as current use land (open space, farm ❑ ❑ and agricultural, or timber)? Chapter 84.34 RCW X Exempt from property tax as a nonprofit ❑ ❑ organization? Chapter 94.36 RCW X Seller's Exempt Reg. No. _ — - _ _ —, Receiving special valuation as historic ❑] Property? Chapter 84.26 RCW Property Type: Cl land only ❑ land with new building Kland with previously used building ❑ land with mobile home ❑ timber only ❑ building only Principal Use: ❑ Apt. (4 + unit) kresidential ❑ timber El agricultural ❑ commercial/industrial ❑ other ® (1) NOTICE OF CONTINUANCE (RCW 84.33 or RCW 84.34) If the new owncr(s) of land that is classified or designated as current use or tbrest land wish to continue the classification or designation of such land, the new owner(s) must sign below. If the new owner(s) do not desire to continue such classification or designation, all compensating or addi- tional tax calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34.108 shall he due and payable by the seller or transferor at the time of sale, The county assessor must determine if the land transferred qualifies to continue classification or designation and must so indicate below. Signatures do not necessarily mean the land will remain in classification or designation. If it no longer qualifies, it will be removed and the com- pensating taxes will be applied. All new owners must sign. This land ❑ does ❑ does not qualify for continuance. Date DEPUTY ASSESSOR (2) NOTICE OF COMPLIANCE (Chapter 84.26 RCW) If the new owner(s) of property with special valuation as historic property wish to continue this special valuation the new owner(s) must sign below. If the new owner(s) do not desire to continue such special valuation, all additional tax calculated pursuant to Chapter 84.26 RCW, shall be due and payable by the seller or transferor at the time of sale. (3) OWNERS) SIGNATURE Description of tangible personal property if included in sale (furniture, appliances, etc.) If exemption claimed, list WAC number and explanation. WAC No. (Sec/Sub) Explanation I TypeofDocument Statutory Warrant)i Tipp-tj June 17, 2002(See Su}.)31,Stmt) Date or Document — Gross Sale Price $ 88,000 Personal Property (deduct) $ Taxable Sale Price $,881000 Excise Tax: State $ Local $-L�(i^-7 ,Delinquent Interest: State $ Local $ Delinquent Penalty: State $ Total Due $ 1._,56 6 4 0 WRE IS A $2.00 FEE FOR PROCESSING THIS FORM IF NO TAX IS DUE AFFIDAVIT I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct (See back of this form). /^ Signature ofg e14 -i. j� (mac 12�•G? �' GLS : , Grantor/Agent Name(print)Elsie E AndrT- - TrttatPk Date &Place of Signing P.T.,11A 6/17/02 Signature of � yj�rY e{-- Grantee/Agenjm!ees!�G_ilmore Name (print) Andrew _ Date & Place of Signing .P.T. ,WA $/17/02 Perjury: Perjury is a class C felony which is punishable by imprisonment in a state correctional institution for a maximum term of not more than five years, or by a fine in an amount fixed by the court of not more than five thousand dollars ($5,000.00), or by both imprisonment and fine (RCW 9A.20.020 (IC)). REV 84 0001a(6.16-95) (PL) 12-17.97) FOR TREASURER'S U $ NLY 095194 COUNTY TREASURER ( .� 951.94