The URL can be used to link to this page

Home My WebLink AboutSEP1973-00269 frtsh11 1 A -,spa. 903 E. Caroline OLYNOiC HEALTH DISTRICT Permit No. ` 33 17 SD Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION E-1 '7 0U7.6., " Submit in Duplicate Builder • Court House Port Townsend Date .q31 f - OWNER G0 2440-d-i ADDRESS 41741Z PHONE 3fS DIRECTIONS FOR LOCATING SITE 164;x4. g i I r � 2 ! 14..„,4%.4 - 14�L. ' .L% ' At_ aL// C trLa,J :2tj _' /(� 7 - ,-/ - 0-24, APPLICATION IS H REBY MADE TO: INSTALL Nom? SYSTEM REPAIR EXISTING SYSTEM A P t OF BUILD 0. OF ;LOOMS j BASEMENT I IfirtfiSTII NAME i INS ALLER 3 01. 100 .Z� DRAINFIELD LENGT 0∎, ' ` D - 27/ DEPTH ors{ if SEPTIC TANK SIZE .. DRAM A_DETAILED PLOT PLAN BELOW. SEel5tIgtanINS. SOIL TYPE &Hi(' e cNt X00 0 S :7_,,,—0,•- f, . A p---- /5-6 i . --7 r: • lie .75, 1 lift:,,,,41') ci:) w - ' gast 1,, 4 ere,c,,:2-- .-er '-1 7= . - 50 - rl ti, i, 1 . ' v no n Gti, 11 Z�4 -t4-, , .ANY CHANGE IN BUILDING OR SETAGE DISPOSAL PLANS, L ATION OR SITE, INVALIDATES TIIS PERMIT UNLESS PRIOR APPROVAL OTAINED FROM THE HEALTH DEPARTMENT. DATE O�FI INSTALLATION � E 2 73 SIGNATURE OF APPLICANT APPROVED 1 C f ? 3 DATE... INSPECTED BY -' L"- ---- - DATE (eft-1/73. SANITARIAN'S COMMENTS: -5� c �� v•_--cz S t--eSSc� ,3� 0 �` S c� � s`! Q:�gc c �...... r • 5 \Vie.\ (, )-\-) " ‹'`.- - S J.� C .'4 . .Z°\ ..V %s \„ \ap `a_re_.r - I CERTIFY THAT THIS SY M '.'AS INSTAL if IN TIE V'I'NE; APPROVED BY THE 077.....?HEALTH DEAPRTMENT _ DATE INSTALLERS NAME 5 .,,,..rte 7 ,. — '••..s, c••\\. ∎v-.cVUa.o -.P._l`-) Noweopogralw CI. i r l L • ♦'!'� •mar. \ 1 r \..4..-� a • ,.s,� 3 1,„0_, .....“ -1/4-.-..r.. C :4'4: 'i\14-N4;4°•'1/47.4.0.- r--11112.5- II a._ . . , em c,.__41;_ormil......... ,e s.....,..., = ... 1 1 p • H'.... 1. . . k ,iny..4,--) 676 — 1 tbok i , i 6:1 ` '� .•lb. -.)(44Z s I • X19 ' 1 Cou. _� . _ ___... / • y I • . 4 4/' . ve ' - '151- '3' r ....... -.ter ._ c „. ...k*' • • - 903 East Caroline OLYMPIC HEALTH DISTRICT Permit No, Port Angeles Fee Paid " SEWAGE DISPOSAL PERMIT APPLICATION ), • Submit in Duplicate NAME . ��( tlq�t ' ADDRE,S3 fi.. DATE 11/.16* /76 LEGAL DESCRIPTION P15 IL'/ p br K e PHONE .#1/ / DIRECTIONS FOR LOCATING SITE APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEMREPAIR EXISTING SYSTEM Pua .wc,u Yl c /00 n X/0 0 HYPE OF BUILDING NO. OF BEDROOMS BASEMENT ` SITE SIZE NAME OF INSTALLED ON THE REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATIO' 1. Property lines 7. Driveways, patios, carport, etc. 2. Location of building 8. Streams or bodies of water nearby 3. Location of septic tank 9. Location of percolation test holes 4. Location of drainfield 10. Septic tank size MO gallo . 5. Slope of land 11. Length of proposed drainfield 6. Water lines & well(if applicable) 12. Depth to water if encountered. PERCOLATION TEST RESULTS 411 Depth Time required to -Percolation rate Type of soil of hole seep last 6 in. (divide time bye S �a �� Perc. No. 1 1IA'Y- Perc. No. 2 r1 4 • -1 NY /� .� Perc. No. 3. C_ r p L=�:_ CY, 'i5.�i} ,;: „.0k DRAINFIELD LENGTH / o1Lp' WIDTH dX f DEPTH ,i fo•-d$" NO. OF IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION ILL BE MADE IN THE MA/1142R AS DESIGNED AND APPROVED ON THIS APPLICATION. ' NEW { Signature of Applicant APPROX. DATE OF INSTALLATION C SANITARIAN'S COMMENTS:� y ,s C" d\NA ("\ . THIS CONSTITUT A PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROV- PLAN APPROVED v DISAPPROVED DATE J 7`? DATE INSPECTED SANITARIAN REMARKS: 5-68 � �e 8 4=s-C `�-��t :.�\l�\ ��\ �•■\ �vc r y o,,n 1 1, . ,,," - ...„ 1 ,,: • { I ; I I ii, . I\ . , , , I 1 . • I 1 1 1 , oo I i, __' . >,- , , _ . i t t i 1 3,1 2, 1 - --.. .. ,` c! a Q(, cq 0I 4,1 n�tt'a, 1. e . A E-III 4, 1116 .,.,. 0 _ J . - -7---) .„. . 6. _ 1 ' 1 • A, , . . I.,. , ..,_ 5 . (-----? ,,,, . L 11., a 0. [ I I LP b .- ,i , , ...,,-,..--„,_ oi , . ,......, ,„,,,m. ... ......, i . . ut ... si i i 1/ x. • t---4-- .I Q/ i 1 I I • t I I i I .► i 1 A 1 "'mom asdoIaNI sari mamma Ina OT--rums ' -1 s r a /�' C " ' . "--- ) ---g--e- c___e_V_Ze.--4.1 . / 1 , e . A-A, . .. .,A c.,„Zzte. 4_,e1../ L_..c....4.1 (---d--et-z--6--f--/. c--I--e--/ c-i:-.-.) gez_z_e_.....__<_,, C.2:6 c.t'e ,7„ c.-, LP cue ei..... )-cam e .'"" - • t.. 93(--,c-tele47 let# / - ..¢. - / ,__,ee_/.e_e_. ,. .?;) ,er--/— ---e-e-a,"--,--‘-7 1 ("4-, 0 s— /1 J/. (-----/4-a_i L..4. // \ !'s1- k - ` ._�w'"%., v`-;C; - ....�......, .. - .w \,■∎ yv4 -' I¼, ., ...r to A, ‘>-- ).:`e--5 c.. 1 \.scv.-) V. .J~R •V yeti. ) a, .q., \;in- - -e_Lo.J..,-e, k., (csv-% );a-L , 6 C • -1))(:::-.2`. `2.---) ■2\--\- -' -3..? N '-4 ..'S..‘.... Ih..m),■ C '''""V .-'":":-. ,-J4 , c,,_________ n sz) c-,-,:,-ate \'c"=� 51 S !Ca 1'?2 CAr \ r \\/... -",ps- Q • , S\,fi s S.e.:. .u - • ,y Rte:.-•. • THIS NOTICE DOES NOT EXCLUDE YOUR CHILD FROM SCHbOL Olympic Health District • Parents or Guardians: You are hereby notified that the child presenting this notice has been exposed in school to whooping cough. Kindly keep the child under observation. If symtoms of the disease develop, keep the child at home and consult your family physician. Also, notify the school, A release slip from your family physican is necessary before your child returns to school. Your cooperation in this matter is strongly desired to prevent further spread of the disease. Respectfully, (Mrs,. Marion—\T. butler Olympic Health District nurse • Date of Exposure: WHOOPING COUGH: Early stage resembling "cold, with slight fever, nasal discharge and cough folloed by progressi..vily severe cough in paroxysms which may eid in vomiting or with a characteristic whoop." Particularly communicable in early stage before development of "whoop" . Incubation Period: 7 to 16 days. ;yr7 11 gc ... *914 Cr 9,"-- d de r 14,141)t) • „= _ • • .. n yWd J-,,viives" � y y.� a ,r • • i 111, Date: 4 L 1 �1 � by:f!' Found at:City of PT website Public Works>Maps&Drawings>Record Drawings>Side Sewer As-Bulks 4� 903 East Caroline OLYMPIC HEALTH DISTRICT Court House Port Angeles Port Townsend BUILDING SITE INSP ,2TTON APPLICATION • Submit .i,n Ismycaze OWNER .), ‘_•\\ *.,� `.. . NDDRESS 7?-3 S� DATE 3//'S/7/ �� LEGAL DESCRIPTION L-C V-, ( off �'� � `�� a DIRECTIONS FOR LOCATING SITE �z�-� ,,,, 5 =s_t AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM. PESIDENCE f COMMERCIAL BUILDING OTHER NO. BEDROOMS 3 BASEMENT IJo SITE SIZE/06X100 SOURCE OF WATER C■\Th TYPE OF SOIL S a:-= -`� -)c .x.)t-A,c e DEPTH TO WATER TABLE_____ .•R&W A SKETCH in the space below, indicating location of building in rel&1.L.on to other buildings, property lines, well, streams or other bodies of water. Indicate proposed location of sewage disposal system. • r , O • ..._.._�_..»_.._......_.. :.:_.....� t Date of Site Inspection, 3J147/ :744 T. S SIGNATURE -- IDApproved* � Disapproved * Sanitarian * See reverse side for remarks. THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PEP;,1T J.3 NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD. S • I OLYMPIC HEALTH nTSTRTC - • • - '� cow House, Port Townsend, Wa �t�88368 c--N---- Fleet Caroline OLYMPIC HEALTH DI,STRRI Permit No. -Angles Fee Paid $• SEWAGE DISPOSAL PERMIT APPLICATION Submit in Duplicate z\ __ \ o e 'S ADDRESS DATFS l AIa7171 LEGAL DESCRIPTION L-s=, �a �- , Nc. t'tO mac' PHONE, DIRECTIONS FOR LOCATING SITE - c i \ APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM,REPAIR EXISTING SYSTEM -?cec + tYPE OF BUILDING NO. OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLER_ _-ON WININ REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOG FORMATI( c ) etc. l , £ragerty lines _ 7. Driveways' patios, carport! 2. Location of bull in 8, Streams or bodies of water nearby. 3._._Location of septic tank 9. Location of percolat•on test holes. kw-Location of drainfield 10. Septic tank size 1`0 1' a ' 5-.Slope of land 11. Length of proposed drainfield Er.--.dater lines & well(if applicable) 12. Depth to water if encountered. • PERCOLATION TEST RESULTS Depth Time required to Percolation rate -ype of so 1 of hole see last 6 in. vti�� p (divide time by � � Perc. No. 1 ' .�. A.:-''` Pere. No. 2 Perc. No. 3. a DRAINFIELD LENGTH ' `� �' `� ,�-�.,"rC�s WID�H DE' R NO. OF LINES_,_____.: I IS Jii EBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER AS-DESIGNED AND APPROVED ON THIS APPLICATION. Signature of Applicant APPROX. .DATE OF INSTALLATION SANITARIAN'S COMMENTS: c) eC-e-r fk ' 1"-ss • `=' �\ �e chi -"THIS..CONS UTES A PERMIT WHEN HEALTH OZFICER'S AT ApPPEARS APPRp�Li�s PLAN_APPROVED ._ . DISAPPROVED DATE DATE-INSULTED `,,SANITARIAN REMARKS: Cam--L s - I CERTIFY THAT THIS SYSTai WAS INSTALLED IN THE MANNER APPROVED BY THE MULTI DEPARTMENT. INSTALL.ER1S NAME DATE SKETCH PI AN ON GRID BELOW SCALE--10 PEET BETWEEN LINES " INDICATE NORTH III T f w ; s w T , t i . . . ■ r 1 i 1 I ∎ 4- 1 1, . ;( , f 4 • • . .4 ,. 4 I. I ` 4 I r . i .