HomeMy WebLinkAboutSEP1970-00120903 East Caroline OLYMPIC HEALTH DISTRICT Permit No.
Port Angeles Fee Paid $ d - L'
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate
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HAMS_ r'Q K � uST�r �e ADDRESSy Lp� e g o% DATL" I-� •`7d
LEGAL DESCRIPTION PHONE /
DIRECTIONS FOR LOCATING SITE i Ml i` So , p .,6w,1, 2„�•,1 —a h �e-E r �$c✓ess (•b�- f4 -rias
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APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM
REPAIR E7CISTING.5YSTEM
E@ F BUILDING I MO, OF BEDROOMS I1BASENENT IS'= STZE I NAME OF INSTALLFr i
1. Property lines
2. Location of building
3�100ati.on of septic tank
4, Location. of drainfield
5"lope of land
6. Water lines & well(if applicable)
PERCOLATION
uepsn 1xime required tc
of hole seep last 6 -in'
Pero. No. 1
Perc..No. 2
Pero. No. 3.
7. Driveways, patios, carports etc.
8. Streams or bodies of water nearby
9. Location of percolation test holes
10. Septic tank size 0®a gallon,!;
11. Length of proposed drainfield
12. Depth to water if encountered.
TEST RESULTS
:son rate
time by Q
gvoix l i-Sl,�lc� --
GRAINFIELD LENGTH WIDTH DEPTH NO. OF LINES
IC_.IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNORR
AS DESIGNED AND APPROVED ON THIS APPLICATION.
APPROX. DATE OF INSTALLATIONSignature of Applicant
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SANITARIAN'S COMMENTS: Cat,,0�-4 --70=3177
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PLAN.:APPROVED_S DISAPPROVED DATE -3 -.;2-1(-`0
DATE
REMARKS
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5-68
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