HomeMy WebLinkAboutSEP1972-00203 901, ,t,„Car t, ;OLYMPIC HEALTH DISTRICT Permit No
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�, v.-_ Fee Paid $ ... 40.-?' ..
SAGE DISPOSAL PERMIT APPLICATION
.�w1SrAt....icb qi•1 Aer S\ A erti t. Submit in Duplicate
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itAKAL Voti PwER. Re 0ei ADDRESS FogALSi VliksN,. DATE (0,54 17
LEGAL DESCRIPTION PHONE ?
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DIRECTIONS FOR LOCATING SITE vw�' to Sk=4°4' - A • oi, \v4 Tr,' k 3o \'h
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APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM,_„• REPAIR EXISTING SYSTEM .
t$we rh,frKerk 1 , "Ietit"541ake APti° 11
"YPE OF BUILDING * ►*�+�°�. % ` M - NAME OF INSTALLER
-0N THE REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATI
1. Property lines 7. Driveways, patios, carport, etc.
2. Location of building 8. Streams or bodies of water nearby
,..._Location of septic tank 9. Location of percolation test holes .
4.-Location of drainfield 10. Septic tank size \OO(;' galloon.
5,.--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 to ' Percolation rate Type of soil
of hole ' seep last 6 in. (divide time bye s
Perc. No. 1 0)
Pere.. NO. 2
Pero. No. 3.. —
DRA.INFIELD LENGTH 12_0' WIDTH 2.' DEPTH 1 NO. OF LINES t ✓"-
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MAD IN THE MANNED.
AS-DESIGNED AND APPROVED ON THIS APPLICATION.ii,A// ` 9r l /yy�
Signature; of ?,
plicant
APPROX. DATE OF INSTALLATION io AZ a • kaw ���,". j..� 7"-<-,.`- -,-----
sANITARIANts C MMENT w� o k+e tks i r tw'o rtc T►�,
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-V THIS_C.ONSTITUTES A PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVE''
PLAN APPROVED DISAPPROVED DATE 31
DATE INSPECTED ,,SANITARIAN -�
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REMARKS: 0
a O
I CERTIFY THAT THIS S_S ETI NSTALL 'D IN THE MANNER APPROVED BY T 'i`LTI 0
DERP.RT'tENT. lr1/0 f , :' �
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IT 'TA ER IS NAME E
5-66