HomeMy WebLinkAboutSEP1972-00014r
Sant Caroiine
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SUP)
MUn DISTRICT Per% t No
Fee Paid v4
DISPOSAL PERMIT APPL=TMN
Submit in Ralicate
LLGAL _DESCRIPTION IL
DIRECTIONS -FOR LOCATING
!Wert' 16` . . lo.
APPLICATION IS HEREBY MADE
-b
O
T /e) ,1—
INSTALL NEW SYSTLNI_,, REPAIR EXISTM SYSTEM
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EM-OF-Emu-Ino
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:.. _Wa' -or" MS
N SIDE.
DRA .;A ETA_
1# ,Pr� lieges 1
2, Location of building.
Lion of ''septjc tank
of draintield
�land
& well(if appII s
epth Time re44'
of hole seep la's'
Pere. No. 2
Pere. X,0, 3 •_ '
TSBAI F'I LD LENGTH s W1D
le
Od
BASEMENT SITE 6xZE � N OF INST.4 R
.PLOT P :GIVING HE FOLLOWING I111FORMAT GI
?. Driveways, patios, carport, etc.
8. Streams or bodies of water nearby
9. Location of percolation test holes �
10. Septic tank size b,..,�
ll. Length of proposed draznfiela
i 12. Depth to water if encountered.
:ON TEST RESULTS
to Percolation rate Type of soi
6 in. (divide time by �
DEPTH `f -f 3 �L � ENO. OF
... .�..•" .....�,,,u ,�4, e,y rnts't' ins XUYUbZD INSTALLATION WILL J52; NAVZ-uY rmu •• ,•• -, »-
- AS- MIGNED AND APPROVED ON IS APPLICATION. t
S�igaature of ApplIcant
II
Ui
-APPR(4w DATE OF INSTALLATION II
..SANIT"IMIS COMMENTS:
REMARKS: 316
10ERTIFY T11AT T SY Tal �?
DEP;A.RTKOT .
DISAPPROVED DATE eO
3�IIN 4LLED IN THE MANNER APPROVED BY TAE I�fik
NAME / �D..TE
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W0,40T ( �!` .rd7
1'
BUILDING PERMIT APPLICATIONK'�
z,
a an Department • County Courthouse • ?ort Tow..
Jefferson County Bud � FEET
NE
ROAD
1. LOCATION: Wop aphac mme S W SIDE OF ROAD
N E ROAD AND
S W FROM INTERSECTION OF -
other specific location or landmark
LEGAL DESCRIPTION: L____ of Block
II. TYPE AND COST OF BUILDING
TYPEOFIMPROVEMENT
❑ New building
01gddnion
�0 \Alteration
D Repair, replacement
O Wrecking
O Moving Ireloca`ron)
p Foundation only
OWNERSHIP
❑ Private (individual, corporation.
nonprofit institution, etc.) v't.)
❑Public (Federal, State or local go
COST
• Cost of improvement..... .
To be installed but not included
in the above cost
a. Electrical ------------------
b. plumbing --------------------
BUILDING TYPE
0 Single Family
❑ Multi - Family
number of units
C3 Hotel, Motel, Dormitory
number of units �----
D Mobile Home
er — Specify
UBC OCCUPANCY GROUP:
r�
MOBILITY T% L V I_ I " r— —
❑ New County Resident
,Is this slruCture 'l��-3h��s�ential
of commercial needs of those employed
TOR"
'
a
at either the 10l 1 7
Indian It an HEALTH DEPT.
❑ YES ONO
USE
y Full -tirne Residence
❑ Second Home: Recreation Cabin. etc.
❑ Second pe omaanent residence isle+ to
(Omit cents) Nonresidential — Describe in detail proposed use of buildings, a g., food
processing plant. machine shop, taundry building at hospital, elementary
school, secondary school, college. parochial school, parking garage for
department store, rental office building. office building at industrial plant.
proposed
If use of existing building is being changed. enter,
1
r; Heating, air conditioning ------ -
d. Other (elevator, etc.)......... .
_ • TOTAL COST OF IMPROVEMENT
111. SELECTED CHARACTERISTICS OF BUILDING -
b �
+I
3
0
do
1
d
s �
F=-
PRINCIPAL TYPE OF FRAME
❑ Masonry (wall bearing)
D Wood Frame
❑ Structural steel
❑ Reinforced concrete
❑ OtNr — $ eify 1 i 1
U
_�f
PRINCIPAL TYPE OF HEATING FUE
D Gas
D oil
Electricity
D Coal -
❑ er — Specify
IV. IDENTIFICATION -
Name
` r
Owner % l
2.
TYPE OF SEWAGE DISPOSAL S��g�
[3 Public or Private , _ 1
ZJndividua septic tan etc.)
TYPE OF WATV,; Y
JaPublic or `private ompany
❑ Individual (we , cistern)
TYPE OF FIREPLACE
TYPE OF MECHANICA
DIMENSIONS
• Number of Stories - _ _ . - - - - - -
•Total square feet of floor area,
all floors. based on exterior
dimensions ---------- •--------
• Total land area, sq- ft-----------
NUMBER OF OFF - STREET
PARKING SPACES
Enclosed.
-7p'--
RESIDENTIAL BUILDINGS ONLY
Number of bedrooms . - -"
Number
Full- . - - - - --
Partial - - - - --
ZIP code Tel. No.
mailing Address Number Street City I �T �� /`�
0
3. JEFF. C`0UN T Y
Architect
ned agree to conform to all applicable law�lE.ALTH DEPT,
Application date
The owner of this building and the undersig Address
.anaI of apptrcani .r-\
WATER DISTRICT
FIRE DISTRICT. -2--- SCHOOL DISTRICT____- -
PLANNING AREA
APPROVED BY
aErnt PERMIT NUMBER
,sErrEr "'I Courary PERMIT FEE ISSUE DATE
APPROVED BY:
IS
13UILDING OFFICIAL
- SITE EVALUATION REPORT
JEFFERSON COUNTY HEALTH DEPT.
Multi- Service Building
802 Sheridan Avenue
Port Townsend, Washington 98368
(206) 385 -0722
Applicant __ Jay Russ
Address:
210 Adelma Beach
Port Townsend. WA 98368
Telephone: 385 -4052
THIS REPORT DOES NOT CONSTITUTE APPROVAL OF A
BUILDING OR SEWAGE DISPOSAL PERMIT. THOSE
PERMITS SHALL BE GRANTED ONLY UPON APPLICATION
AND WILL BE REVIEWED IN ACCORDANCE WITH
CONDITIONS AND REGULATIONS EXISTING ON THE DATE
OF THE PERMIT APPLICATION. TFIIS REPORT IS NOT A
PERMIT APPLICATION.
Receipt No:. 00367
Fee: $45.00
Date:._ _ 6/25/85
Sec. 32 Twn. 30 _Rg 1W _
Block 19A
Legal Description (D-r _ etk.. Lot) — —
Directions for Locating site (Draw map on back).
Site Size 50 x 250
Seller Harriet Halterman
Buyer Jay Russ - Janet Russ
x evaluate existing system
I request this site evaluation for single family residence or - -- — - —
installed 1972 t replacement (W. H. Herman)
INSTRUCTIONS: A minignum ag jWn SnIl Ing hnipn sit 1p_a�* A feel deep, 9 'Pat diagueleg -ad 50 lost aparl must hp d,,g ffia fbe pgopo�x-d
See attached instruction sheet.
A site evaluation of the above property was made on _ 26 June 1985 _
property has been found:
ACCEPTABLE - Soil and si conditions are acceptable for staII tlon of a sewage di:
existing con it ns and regulations.
O CONDIT NALLY ACCEPTABLE - Soil d site conditions are acceptable r installation of a sewage di
above, der existing conditions and regu tions, provided THE CON
ARE MET\unacc 13 UNACCEPTABLE- Sol nd site conditions atabl e for installation of aseptic
k system.
by this department and the
as requested above, under
system, as requested
&SET OUT BELOW
COMMENTS-
As of this date the system was functioning in an approved of manner. Great
care should'be taken in replacing the house foundation that the drainfield
is not excavated or driven over.
SOIL LOGS:
Respectfully,
JOHN YES, R.S.
ENVIRO ENTAL HEALTH SPECIALIST II
i