HomeMy WebLinkAboutSEP1972-00200 SEP 72 '60 W
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e" 90, East Caroline OLYMPIC HEALTH DISTRICT Permit No. .Job 74
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SEWA,CsE DISPOSAL PERMIT APPLICATION w
Submit in Duplicate !
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Paulson Martin ADDRESS Graylv.nd, WA X8547 DATMr, - ,.
LEGAL DESCRIPTION Lot 5, Sec. 31) Tsp 25N R2 WtM PHONE
DIPP,CTIONS FOR LOCATING SITE On P.S.H. #9, Stratton 0ev. ner County Line-.Q4 4t
Triton Cove
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM ='- REPAIR EXISTING SYSTEM
House \.;,�;„��_ 9,020 sq.ft , irdSc
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JYPE OF BUILDING NO. OF BEDROOMS BASEMENT SITE SIZE NAME OF INS LLER
,,,T) _ �_.
- --t�Pd THE REVERSE SIDE, DRAW-A DETAILED PLOT PLAN GIVING THE FOLLOWING INFDRMATIi
1. Property lines 7. Driveways, patios, carport, etc.
2. Location of building 8. Streams or bodies of water nearby
3.__Lacation of septic tank 9. Location of percolation test holes
IZ 4. Location of drainfield 10. Septic tank size IC,L c, gallr�zus
5 -Slope of land 11. Length of proposed drainfield
Q 6-._Water lines & well(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
Depth Time required to '-Percolation rate Type of soil
of hole , seep last 6 in. (divide time by 6) , a l'-'Perc. No. 1 i;-\ v�'�. "N..c- 1
Perc. No. 2 """_"'"”" .
Perc. No. 3. c.
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DRAINFIELD LENGTH ••
tJ� i DEPTH -3N0. OF LINES
_
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER -I
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AS-MISIGNED AND APPROVED ON THIS APPLICATION.
Signature of Applicant
APPROX. DATE OF INSTALLATION
SANITARIAN'S COMMENTS: - A.,Q-_,, �, .,
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-"THIS._CONSTITU ERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVE c>
PLAN _APPROVED -1 _._ DISAPPROVED DATE________ ( 4
DATE_.7�tSPECT.ED�:-=� '*-- - VS
\�--*�e r}r-� N,b L..�"SANITARIAN .. >___.% d
REMARKS: c, rt N
I CERTIFY THAT T1 ► AS 1ST uED IN THE MANNER APPROVED BY TAE- REAM
DEPARTl`- NT. , .......ez_ .- .
e I TST LLr2R' S NAME D<LT.}
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