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HomeMy WebLinkAboutSEP1996-00273 Jefferson County Permit Center, 621 Sheridan, Port Townsend WA 98368 SEPTIC PERMIT APPLICATION PROPERTY OWNER G E.C' 1 MAILING ADDRESS P-0 . 8c3>c S©(.oa Po r k V-uA A 3 Los PHONE Area Code ( 3Co0 ) 31 - CRC\-3a SYSTEM DESIGNER Lc LEGAL DESCRIPTION: Section Township at Range \ E PARCEL # `Era ( diva CD8® Subdivision Name t cth•s atca.C\f-\ cc C\ . Division Block Letfs) (cA54"(09. SITE LOCATION ` � ( C� c/A J . Po c k. L O�� �� A Zip Code ��3 TYPE OF IMPROVEMENT: Residential Commercial Community TYPE OF WORK: New Redesign Upgrade Repair 1K Partial (tank) (drainfield) Conventional Alternative k Drainfield Length 3® ft. Number of Bedrooms p� Trench Width (3 ft. Basement: yes / n Trench/Bed Depth tO in. Site Size +�i-k DSC. Number of Lines 3 Previous evaluations / no SEP � (AC O)Tank size -"15Q gal. Water Source: private\°v( public Soil type 1k (ATTACH SOIL EVAL.) Application Rate • 11) gal./sq.ft./day TYPE OF SYSTEM 36'vy-C\C\ \k �'1C /Qr.‹.)-::)LA;Zc (-\ • THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES. Signature A cur. r. (- ;( i 1 -r Date C9 FOR OFFICE USE ONLY Pr��es (9rsC • Ce ) `b jQ-eta 5I,0-llqt- APPROVED PARTIAL �`t- NAL 1 RENEWED.' RENEWED Fire District 3 Planning District ] School District Zone Dates % < Fee 1\)A Rec # Check # Case # SEP CI � 3 q