HomeMy WebLinkAboutSEP1971-00079East Caroline CLYMPIC HEALTH AISTRICT Permit No.-4f96�4,�,�
Port Angeles Fee Paid 5 „p
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Durl1catee.
I -'Ilk DATE
a ! Ira/r!♦..far•.i�l ;!4_�i e9L3r�.. 1 Y:.L I ! s�iil'r!4.�,f 8a �
LEGAL DESCRIPTION �C;'® �� � � � ,� � PHONE
UbiP.. 1—.ii.r rrr r�lr�.r+li.YMlrr�1 rl .ir Yr.
DIRECTIONS FOR LOCATING SITE
APPLICATION IS HEREBY MADE TO: INSTkLL NEW SYSTEMREFAIR EXISTING SYSTEM
YPE OF B : DING NO. OF ,BEDROOMS' BASEMENT SITE SIZE NAME OF INSTALLFP.j
ON THE REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORNATIO
1. Property lines 7. Driveways, patios, carports 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 �S�gallon.
5. Slope of land ll. Length of proposed drainfield
6. Water lines & well(if applicable) 12«I7ept tai water if encountered.
PERCOLATION TEST RESULTS
Pere. No.
Pere, No.
Pere. No.
"UP -GA ITIme required to Percolation rate
of hole 1seep last 6 in. I (divide time by 6
2
3.
so
DRAINFIELD LENGTH __.,WIDTH ` EPTHNO. OF LINES,,
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
AS DESIGNED AND APPROVED ON THIS APPLICATION.
App
APPROX. DATE OF INSTALLATION S /� 7/ Signature of licant
-SANITARIAN is •-COMMENTS: �-
PLAN
DATE INSPECTED
DISAPPROVED
REMARKS: b`` C����` '� y ,
5-68
SANITARIAN
IPPEARS AS APPS
DATE
0
b
V
'53 East Caroline OLYMPIC HEALTH DISTRICT Court House '-
Port Angeles Port Townsend
BUILDING SITE INSPECTION APPLICATION
Submit in Du;2liccate
OWNER�..� �.� ADDRESS��
LEGAL DESCRIPTION`
DIRECTIONS FOR LOCATING SITE
AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
RESIDENCE,A(�—r-�kN`lb,aOMMERCIAL BUILDING OTHER
NO. BEDROOMS__\.BASEMENT "' SITE SIZES®)Qp o SOURCE OF WATER QC� %--Xvti Az�
TYPE OF SOIL Q K, DEPTH TO WATER TABLE
DRAW A SKETCH in the space below* indicating location of building in relation
to other buildings, property lines, well, streams or other bodies of wtLter.
Indicate proposed location.of sewage disposal system.
s
S'v
�G�
Date of Site Inspection S A �7 ( APPLICANT tS SIGNATURE
Approved*!_ Disapproved
* See reverse side for remarks. Sanitarian
THIS IS ]JOT AN APPLICATION FOIZ A SEWAGE DISPOSAL PERMIT. A SEPARATE PER"WIT IS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.
- Z7
—1
X
X
–h
0)
--
--
t�1
-0
co
- CL
C-3
rt
X
Cu
n
d
O
--0
-i
-3
7 C
CL
CD
d
n
CD
--
CD
c
CD
CD
r+
o
CD
—
n
E
._
C=)
=3
J
rU
CD
C-3
7
CaJ
-5
CL
O
C:3
M3
O
a
0
7
—1
C.O
J
H
m
C"
CA3
OO
-�+
O
-�
C=
C=
f
-c^
Cl3
C:3
m
O
rf
rt
H
OD
m
'0
m
v
c
C"
r—
Cn
=P-
CD
n
n
m
o
---1
:;o
O
SD
C
—1
—I
771.
--q
v
C7
•
x
—I
m
H
CL
cn
cn
M
•
m
ry
—I
m
v
C_
oo
r}a
•
=C>
—y
•
a
C-:)
v
--C
na
Cao
ry
•
r
-C
-h•
m
v
ry
o
•
m
m
r+a
w
•
s n
r
�.
Cb
c
O
C3-
LO
0
c
CL
CA
CD
CD
C.0
O
O
—1
0-0
C
Z
T>
C3
C3
C3-
=>
C-3
O-
=r
�'
c
a
cc
cc
CL
.+
Z
o
—1
c
v
C3
r
-3
O
O
=01.
ca
—
CL
cn
=VP
C4�6
w
—CD
�•.
v
z
C"
- -
• -
c)
r\,3
cn
—�
O
H
C-3
T
Z
CL
-n
a
co
c
m
H
C3�
�
-.0