HomeMy WebLinkAboutSEP1972-00040`et Caroline OLYMPSC HEALTH DISTRICT Permit No. 5 0�
roe Paid _ $ t6 °c . °�_...,...
SEWAGE DISPOSAL PERMIT APPL=TION
�"... _ Submit iz► Durilicate
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DATE. 4/W7-
`'4t•A � �. I�� °.:4a°� �� Ee a �. � ADDRF,.SS � i �L Y ���t� � �_ . -
LEGAL DESCRIPTION PHONES,,,,,
DIRECTIONS 'FOR LOCATING Sl'E
,. APPLICATION IS HEREBY MADE TO: INSTALL NEt� SYSTEM � WAIR EXIST SYSTEM...,
1.- Property liiaes 74 Driveways* patios, carport4 etc.
20' Location of building 8# Streams or bodies of water nearby
3.- „,Location of septic tank 9. Location of percolation test hole4
-aaton : of_ drainf3�,ld _._. 10. Septic tank size 6 t ^�„ &
S
,5 -Slope of land 110 Length of proposed drainfield
6;. —Mater lines t we:ll(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
MR” -of
Pere. No.
Pere.. No.
Pero. No4
of hale
DBAINFIELD LENGTB�
last 6 in. (divide time by A
'IDTH [ DEPT NO. OF LINES, --
.ka. .a.+a ,..- .aza:+Li n�n.r�.e,lu J:i1tiT :I:1�L' YtiVYUaLilJ .I.lY:!'1'ALLH'1'lUPi W1LL ,D:� rini+�+ .ra► ...... - - --
AS- DESIGNED AND APPROVED ON THIS APPLICATION.
',.. ligaMr7pf 1pplicani
-APPROX.- DATE OF INSTALLATION 75,1.\..�.�,..�.�.,....
XTkRIAN'S COFMKMS i .0
`" M,GONSTIT ESQ
OW-APPROVED
REMARKS
Cpl
ALTS OFFICER'S SIGNATURE APPEARS AS APPS;?
DISAPPROVED DATE -2 - '
00 Q
fiI .W IN. Mt iNER �PpR0V� BY T13E I,TL
DEPART T.
IE
.V ALLt - .� DxTS -
5 -4
�- gOF
� y
' BD'ILDIJJG� '' K0. Off' BEDROOMS
BASEMENT S
OF INSTALLER
.-ON
THE REVEM S DE. DRAW A " DETAILED
PLOT PLAN 4IVING T$E
FOLLOWING INFORKNXIC
1.- Property liiaes 74 Driveways* patios, carport4 etc.
20' Location of building 8# Streams or bodies of water nearby
3.- „,Location of septic tank 9. Location of percolation test hole4
-aaton : of_ drainf3�,ld _._. 10. Septic tank size 6 t ^�„ &
S
,5 -Slope of land 110 Length of proposed drainfield
6;. —Mater lines t we:ll(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
MR” -of
Pere. No.
Pere.. No.
Pero. No4
of hale
DBAINFIELD LENGTB�
last 6 in. (divide time by A
'IDTH [ DEPT NO. OF LINES, --
.ka. .a.+a ,..- .aza:+Li n�n.r�.e,lu J:i1tiT :I:1�L' YtiVYUaLilJ .I.lY:!'1'ALLH'1'lUPi W1LL ,D:� rini+�+ .ra► ...... - - --
AS- DESIGNED AND APPROVED ON THIS APPLICATION.
',.. ligaMr7pf 1pplicani
-APPROX.- DATE OF INSTALLATION 75,1.\..�.�,..�.�.,....
XTkRIAN'S COFMKMS i .0
`" M,GONSTIT ESQ
OW-APPROVED
REMARKS
Cpl
ALTS OFFICER'S SIGNATURE APPEARS AS APPS;?
DISAPPROVED DATE -2 - '
00 Q
fiI .W IN. Mt iNER �PpR0V� BY T13E I,TL
DEPART T.
IE
.V ALLt - .� DxTS -
5 -4