HomeMy WebLinkAboutSEP1970-00058903 East Caroline OLYMPIC HEALTH DISTRICT Per4it No. D
Port Angeles Fee Paid
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in DgpUcate
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NAIL. / ADDRESS zcr 7� 4 �o°✓ 7 DTE 7- 7®
LEGAL DESCRIPTION --�� PHONE
DIRECTIONS FOR LOCATING SITE 04llop c (, kA/al / i- k c. 3
APPLICATION S`HEREBY MADE T0: INSTALL NEN SYSTEP2_2LREPAIR EXISTING SYSTEM
7'ra1
OF BUILDING I 110. 'OF BEDROOMS I BASEMENT I SITE SIZE
E REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING -
1# Property lines
2. Location of building
3. Location of septic tank
4. Location of drainfield
5. Slope of land
6„ Water lines & well(if applicable
PERCOLATION
vepth Time required to
of hole seep last 6 in.
Pere. No* 1
Pere. No. 2
Fere. No. 3.
NAME OF INSTALLER
7. Driveways, patios, carports etc.
8. Streams or bodies of water nearby
9: Location of percolatio test holes
10. Septic tank size 7® galloan
11. Length of proposed drainfield
12. Depth to water if encountered.
TEST RESULTS
Percolation rate Type of . -Soil -- - -_
(divide time by 6) ®�
GRAINFIELD LENGTH ® WIDTH _DEPTH � NO. OF LINES
AS DESIGNED AND APPROVED ON THIS -APPLICATION.
APPROX. DATE OF INSTALLATIONS �� is gnat a of Applicant
e
SANITARIAN'S CO MMENTS:I)K Q5 rveesed v �.4 %%ham 3 r
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THIS CONSTITUTES A PERMIT WHEN HEALTH OFFICERS SIGNATURE APPEARS AS APPROVED
PLAN APPROVED DISAPPROVED DATE 3 -�
DATE INSPECTED SANITARIAN
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REMARKS /°7 ,. 7 a E p
5-68
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