HomeMy WebLinkAboutSEP1972-00202 „, ,:.&;
£ st Caroline OLYMPIC HEALTH DISTRICT Permit N . %/
Fee Paid $ '7.,-.5 ?)
_A� SEWACsE DISPOSAL PERMIT APPLICATION ,-� „`�
Submit in Duplicate 7 2-- a '
,. u0see.i?itwe- 1
ADDRESS DATE CI dprZ o
LEGAL DESCRIPTION 3/ Q ())1 .PHONE. , ..._,„...
DIRECTIONS FOR LOCATING SITE
` ,
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM REPAIR EXISTING SYSTEM..-:_
...w a !
tYPE OF BUILDING NO. OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLER
-ON THE REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORRMATIC
1. -Property lines 7. Driveways, patios, carport, etc.
2. Location of building 8. Streams or bodies of water nearby
3.,.rLocation of septic: tank 9. Location of percolation test holes %`i
4.- Location of drainfield 10. Septic tank size t)C( \\ `' ., gallon, J,,'
55. Slope of land 11. Length of proposed drainfield -
6-....-Water lines & well(if applicable) 12. Depth to water if;,encountered.
PERCOLATION TEST RESULTS
Depth Time required tercolation rate Type of soil
of hole seep last 6 in. (divide time bye
Pere. No. 1 ‘V '�, `c�y . tz,.. i�`-�'I
Pere. No. a s .''`-3. \'` r,
Pere. No, 3. _
DRAINFIELD LENGTH ' -`”‘4"'WIDTH 45 DEPTH ,P-ft. _ . NO. OF LINES,,........
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
AS- DESIGNED AND APPROVED ON THIS APPLICATION. --,
)■LA'Ait, \A- .
Si ature of Applicant
APPROX. DATE OF INSTALLATION A.„
SANITARIAN'S COMMENTS:
:ISl,CONSTITUT (1_PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPS
PLAN..APPROVED --—> _., --DISAPPROVED _ DAT (1_
DATE_ INSPECTED y .c.....,.-.,..,...::, -7: , ,,SANITARIAN t
REMARKS: C
I CERTIFY THAT TH SYST'1 I WAS INSTALLED IN THE MANNER API-ROVED BY T E LT,,
DEPARTMENT. . ,,-E. ,/,- „.
L IS ALLLR'S NAME D1--iTE
5-4i