HomeMy WebLinkAboutSEP1973-0018613ucy3gdoryu
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903 E. Caroline
Port Angeles
OLYMPIC HEALTH DISTRICT
SMIAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate
Court House
Port Townsend Date 23 _
ADDRESS PHONE a Lt
DIRECTIONS FOR LOCATING SITE���.L c
�9:3, 1% .
�5 U� Permit No._If: 33 53
Builder
APPLICATI N THEREBY MADE TO: INSTALL N34 SYSTEM,"'REPAIR EXISTING SYSTEM
DRAINFIELD LErdGTH LfJ: WIDTH 2DEPTH#LINES IC TANK SIZE
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE S �-
SS°
IN
Nz\-;�h \-\�
ANY CHANGE IN BUILDING OR A
SL GE DISPOSAL 'PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
DATE O`�INSTALLATION SIGNIkTURF
APPROVED d...DATE to he !73 INSPECTED
SANITARIAN+S COMMMTS!
OF APPLICANT
BY 6Y,�1__��1zc R�-ZZ:) DATE
I CERTIFY THAT SY F !ASMANNER APPROVED BY THE
HEALTH DEAPRTM�.,NT DATE
TNSTA=RS NAME
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I
Lr_SI�
YPE OF BUILDING
I NO. OF BEDROOMS
BASEMENT.
SIZ
NAME OF INSTALLER
DRAINFIELD LErdGTH LfJ: WIDTH 2DEPTH#LINES IC TANK SIZE
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE S �-
SS°
IN
Nz\-;�h \-\�
ANY CHANGE IN BUILDING OR A
SL GE DISPOSAL 'PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
DATE O`�INSTALLATION SIGNIkTURF
APPROVED d...DATE to he !73 INSPECTED
SANITARIAN+S COMMMTS!
OF APPLICANT
BY 6Y,�1__��1zc R�-ZZ:) DATE
I CERTIFY THAT SY F !ASMANNER APPROVED BY THE
HEALTH DEAPRTM�.,NT DATE
TNSTA=RS NAME
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BUILDING PERMIT APPLICATION ,
Jefferson County Building Department • County Courthouse • Port Townsend, Wash. 98368 • 385- 9141
*
I. LOCATION: geographic name
NE
S W SIDE OF
ROAD FEET
NE
Ludo5AD
S W FROM INTERSECTION
OF ROAD AND
E114T
other specific location or landmark:
APPROVED BY:
PERMIT FEE
/ C)
DES,�RI TION: l
RECEIPT NUMBER
t/
&EGAL
Lot
Block
=T.w,
TaxNumber '/.Section
Stection nh p ange
11. TYPE AND COST OF BUILDING -
TYPEE/O�F IMPROVEMENT
�J New building
✓El Addition
BUILDING TYPE
❑ Single Family
❑ Multi -Family
MOBILITY
❑New County Resident
Is this structure to serve the residential
❑ Alteration
number of units
or commercial needs of those employed
El Repair, replacement
❑ Wrecking
❑ Hotel, Motel, Dormitory
number of units
❑ Mobile Home
at either the U.S. Navy's Trident or
Indian Island Facilities?
❑ Moving (relocation)
6701bther — Specify
❑ YES ❑ NO
❑ Foundation only
j_Le>1zQ 01A Dom-
a ri tv
USE
❑ Full-time Residence
OWNERSHIP
❑ Private (individual, corporation,
nonprofit institution, etc.)
❑Second Home: Recreation Cabin, etc.
❑ Public (Federal, State or local gov't.)
UBC OCCUPANCY GROUP:
❑ Second Home: Future conversion to
permanent residence
COST
(Omit cents!
Nonresidential —Describe in detail proposed use of buildings, e.g., food
• Cost of improvement............
$
processing plant, machine
shop, laundry building at hospital, elementary
To be installed but not included
school, secondary school, college, parochial school, parking garage for
in the above cost
department store, rental office building, office building at industrial plant.
a. Electrical ..................
If use of existing building
is being chapged, enter
b. Plumbing ..................
-prop( �0
c. Heating, air conditioning .....
7
d. Other (elevator, etc.)........ .
$
• TOTAL COST OF IMPROVEMENT
Ill. SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME
[] Masonry (wall bearing)•
j`Wood Frame
TYPE OF SEWAGE DISPOSAL
❑Public or P�rivaa�te
❑ Individua,.)
DIMENSIONS
Number of Stories .............
*Total square feet of floor area,
all floors, based on exterior
tructural steel
dimensions ...................
❑ Reinforced concrete
TYPE OF TER SUPPLY
• Total land area, sq. ft.......... .
❑ Other — Specify
ublic or private company
❑ Individual (well, cistern)
NUMBER OF OFF-STREET
PARKING SPACES
Enclosed ........... .. .
-
PRINCIPAL TYPE OF HEATING FUEL
TYPE OF FIREPLACE
❑ Gas
Outdoors .........
RESIDENTIAL.BUILDINGS ONLY
Number of bedrooms ............
y Number of Full ........
bathrooms
Partial.... .
�0oil
c4Q Electricity
/s
Coal
El Other —Specify
TYPE OF MECHANICAL
IV. IDENTIFICATION -
Name
Mailing Address — Number, street, city and State
ZIP code Tel. No.
Owner
2.
^�.5
Contracto
State cense No.
3.
Li
Architect
¢_ _ -T,
��ai Yom. CL�6
e
The ownAr of this building and the undersigned agree to conform to all applicable laws.
ignatur pplicent
Address
Appltca on date
..
—
PLANNING AREA FIRE DI ICT SC OL DISTRICT
WATER DISTRICT
APP OVED B
Q
JE ER301a65 JNTY HEALTH DEPARTIv
E114T
APPROVED BY:
PERMIT FEE
ISSUE DATE
RECEIPT NUMBER
3 ,sem
BUILDING OFFICIAL
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