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HomeMy WebLinkAboutSEP1972-00064 42:7a- o(364‘ 90,'mat Caroline OLYMPIC HEALTH DISTRICT Permit No. ' "; . Fee Paid $ r` SEWAGE DISPOSAL PERMIT APPLICATION r Submit in Duplicate \\// , f !l✓7.4lN 4Ay (-j . • . / , . A. + mai .._ y ADDRESS `-- /�� 4 A ?-1117,(7. Po f3 G-f 511 Ae,/r111 aAei 1/f silt, WA -984...;;c-9sio /ite-4,,,I -ri : LEGAL DESCRIPTION /... G / ,S 132 c C4' , , Di fI scpae J'` PHONE 131 DIRECTIONS FOR' LOCATING SITE 0 .\ ,,,7/, ( 4 f /, if if I 7/Li1/4• ria_ - 4/ .; i I ( Io0 , 1 - IteQ Ns" APPLICAT 'N IS HEREBY MADE TO: INSTALL NEW SYSTEM ' REPAIR EXISTING SYSTEM rwrwir , 4 7 \ c?c. C A'YPE OF BUILDING NO. BEDROOMS ROOMS BASNT SITE SZ'Z NAME OF INSTALLER_1 . ..J0 THE RSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATIc 1. -Property lines 7. Driveways, patios, carport, etc. ' 2. Location of building 8. Streams or bodies of water nearby 33..._Xocation of septic tank 9. Location of percol tion_test holes C 4.--Location of drainfield 10. Septic tank size i �;� gal.lomc 5. -Slope of lard 11. Length of propose drainfield 6,.-Water lines & well(if applicable) 12. Depth to water if encountered. PERCOLATION TEST RESULTS C bepth Time required to 'Percolation rate Type of soil of hole' seep last 6 in. (divide time bye L Pere. No. 1 s) ( y = --_ Perc.. No. 2 Pere. No. 3. -- v ,r DRAINFIELD LENGTH ULC; / WIDTH ) DEPTH '. '1 (' NO. OF LINES ITISHEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNl K AS--DESIGNED AND APPROVED ON THIS APPLICATION. LA _ -� 4 _ - ..-L, Signature of . •plicant APPROX. DATE OF INSTALLATION No \J4i) � h i` SANITARIAN'S COMMENTS: ' ` O� ! . - „*,A„.). __ 7z91 i (Y_____ -THIS_CONSTITUTES A PERMIT WHEN HEALTH OFFICER'S SIGNATURE ,PPEARS AS APPROVED "Q PLAN APPROVED \-,,i, ...--.....-- DISAPPROVEDDATE, ?!Z( J ?�. pG DATE- INSPECTED `°�,;�;;_� r ,. ,c,,,_ ,SANITARIAN '•,: 'x O REMARKS: 0 0 I CERTIFY THAT"T SYSTEi ovAS , TALL > IN THE MANNER API-ROVED BY THS, HIZALT1 J DEPARTMENT. r t f-i t v �- �((���C - - INSTAL tER l S NAME DA.T. 54j C'! :©avNC2_ t/;z,/q SKETCH PLAN ON GRID BELOW SCALE-10 FEET BETWEEN LINES INDICATE NORTH i r . .11111111.. 1111k !BM alIMI I ii i MEI 1 I r . al i IMI EN - op -, . ,,,..; il i j • Mil I i 11111111111111=11111 III. i MIMS I IIII 11 11.1111111111011111 , ji . liMil Pill , II dilliallIMMEMMIN MEI ME j • 1 IIIIIIIIMIIIIII 1