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HomeMy WebLinkAboutSEP1970-00077-70 y I`I OLYMPIC HEALTH DISTRICT Permit go & t. Caroline �? SEWAGE DISPOSAL PERMIT APPLICATION: Submit_ in Du�.3 c to DATE' f 71. LEGAL, DESCRIPTION � % PHONE , DIRECTIONS FOR LOCATING SITE,,[cqq ' - A`-� 4J c APPLICATION IS HEREBY MADE ST TO: • INNEt , -S $TEM .;@'` � REPAIR EXTSTMG SYSTEM. _; OF BUILDING 1 00, OF BEDROOMS I BASEMENT .SITE 6SZE NAMEJIOF INSTALLER . rwenw rw r c+sLwi+ V ii/h1 �, i/+lti+'w Ra ya,r..�b+r.a+�ai 21 Location of building 3..,Jaocation of septic' tank 4.>Locatiou of drainfield S*..Blope of ]and 6. -Water lines & well(if applicable) 7, Driveways, patiOss c 86 Streams or bodies of g. Location of percolat 10. Septic tank size_,,,,;, "' lie Length of proposed'd 12. Depth to water if es PERCOLATION TEST RESULTS Depth Time required toercolation rate of hole seep lost 6`in* idivide time by 6) Pere, No. 1 Pere.. No. 2 Perc. No. 3. rport' etc. ,A water nearby V " on test holes valloxn; ountered. GRAINFIELD LENGTH WIDTH Y DEPTH N©. OF LINES IT -SS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADEIIIN THE MAPd`,R0 AS -DESIGNED AND APPROVED ON,THIS AIPPLICATION. iature of Applicant -APPROX. DATE OF INSTALLATI0N':. SANITARIANIS COMMENTS: J T"THU-CONSTITUTES A PERMIT WHEN HEALTH OFFICERS SIGNATURE APPEA AS APP S PLAN -:APPROVED DISAPPROVEDDATE DATE INSPECTED \I e 7 SANITARIAN 0 u sTfi;;i.`fa 5-6r$ N ' .l0FEET BETWE �a LINES INDICAh N� RTHSCA i. i I 'I I it 2! I I� LL I �I I, a� i� I I v d'I I I 1 v Ii I I OV 1'. vel it `I � I I � k � E il i 1 11 �If'I I I it I Y i III 1 ii 1 i Ii ...$ VIII I I if I n j 1 I I r I I J I 1 1 i r ^ s i I �I I� 'I I 'I - II I I I I II I ' I. ► Il I F ISG I it 3o _ I II I'I C I: I I r <� )I I I f f i - I it I I It C G ��I I 7 1 I� m I t 5 I I , ff 4 [ ! IIII I I II I I V II II 4 ! I� ( t o I , I III I I it I I Ir c I I.' t _i I I it III � II it u I - I L, f E{ I I { 1 I I. I II i i I - � .. _ I ' h - •`. Y 1 I I i I � t I I { �I I I f T� I � I I `- I 1 I 1 s 4 ,I I I I I' •il I� II hl I• ;� 1 I ' { I hn I M 903 §ffff+,aroline OLYMPIC HEALTH DISTRICT�- Court House Port Angeles Port Townsend. BUILDING SITE INSPECTION APPLICATION Submmi in_ Dutsl�ia, ate OWNER_ , ��,�D %�• ��i� ADDRESS '7,09e2. -.OW2F.- XX DATE -74 7D LEGAL DESCRIPTION 2& Z&-, / r27r/�� ® �' bd°�• 2 0 W R1AJ O DIRECTIONS FOR LOCATING SITE Ike4rhi ®r AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM. RESIDENC . COMMERCIAL BUILDING OTHER NO. BEDROOMS l BASEMENT /!off• S ITE SIZE • f IIRCE OF WTE TYPE OF SOILS _,- DEPTH TO WATER TABLEa. DRAW A SKETCH in the space below,, indicating location of builing in relation to other buildings, property lines, well, streams or other bod es of waters Indicate proposed location of sewage disposal system. C ' VIP, IP d 7 SO V i '311ji v iVOODFD. 23, ®y ® 0 Date of Site Inspection APPLICANT'S SIGNATURE Approved" Y Disapproved ani'I arian rever See se side for remarks. THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PERMIT IS NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAIN�IELD. Parcel # 000502023008 Geo Cd 250202311440 S2 T25 R2W TAX 19 & TAX 33(LS N387') Mode INQUIRY Nbad Cd 1210 * Taxpayer Cd SEGA 1000 SEGAR, HOWARD FRANKLI T/P Chg Dt * Title Owner TO Chg Usr Tax Code 0441 Status TX TAXABLE Land Use 1100 RES -SINGLE Affidavit Val/Page / C/U Code S/C Cd 1 1 !6 0%P79%0%0% A 1- 0% r' 4% AnP.Ar A /A A-! A 1