HomeMy WebLinkAboutSEP1974-00290h ►r�rJI1
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903 E. Caroline _ OLYMPIC 'HEALTH DISTRICT ; Permit No,
Port Angeles �"` ' �~? SDJAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Court House
Port Townsend Date/,L
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OWNER � Li ADD a2 hHONE��
�'� TLE � t►a JJ
DIRECTIONS FOR LOCATING SITE
APPLICATION IS HEREBY MADE TO: INSTALL N' -!,.f SYSTEM AIR EXISTING SYSTEM 1�
v c..4,
YPE OF BUILDING
'"DR00i4S
37 x
N0. 0 BS
BASEMENT
SITE IZA NAME OF INSTALLER
DRAINFIELDLENGTH 1 E;515\%n
.. �II2TH c� DEPTH 3�-� -�#LINIS t� SEPTIC TANK SIZE'.'.'--
DRAW ADETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE
i
q1,1W 116t, le�,�
2 spt- P` 616e-
11
?moo-�ooc
S5 ` I t.- d 7 1-0.
ANY CHANGE IN BUILDING OR SL'AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
T'ER1viIT UNLESS PRIOR APFRC"J_" L OBTAINED FROM THE HEALTH DEPA " M 1
DATE OF INSTALLLLA`TION SIGNATURE OF APPLICAT.
APPIROVED✓ DATE 4A911Y INSPECTED BY /r
SANITARIAN'S COPu'iZITS: DATE \ S 3 ? s �
—� I CT�RTIFY THAT THIS S ,TEM '.,'AS IN1.LLED IN THE MANNER APPROVED BY THE
HZALTH DEAPRTNIENT DATE
IP1S ALLE ANt
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903 East Caroline
Port Angeles
OLYMPIC HEALTH DISTRICT Court House
Port Townsend
BUILDING SITE INSPECTION APPLICATION
Submit in Duplicate
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OWNER ��-��`�j '��+C\� ADDRESS c.�-��\� BATE I 2
�/1■�i��..� . L111 . /.moi
LEGAL DESCRIPTION
DIRECTIONS FOR LOCATING SITE_ _a D �e.�j �� C �ea �(2 [ o�� S ts
AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
RESIDENCE �'' COMMERCIAL BUILDING OTHER
NO. BEDROOMS 3 BASEMENT - SITE SIZE SOURCE OF WATER Q� Ate,■_
TYPE OF SOIL DEPTH TO WATER TABLE
D.•RAW A SKETCH in the space belowq indicating location of building in relation
to other buildings, property lines, well, streams or other bodies of water.
Indicate proposed location of sewage disposal system.
Date of Site Inspection i APPLICANT'S SIGNATURE
Approved'. disapproved
* See reverse side for remarks. Sanitarian
THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PERMIT IS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.
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Parcel Print
Parcel Number. 944400202
Owner Mailing Address:
DAVID EDWARD JOHNSON
830 25TH ST
PORT TOWNSEND WA 98368-7131
Site Address:
830 25TH ST
PORT TOWNSEND 98368-7131
Section:
3
School District:
Qtr Section:
SEI/4
Fre Dist:
Township:
30N
Tax Status:
Range:
1W
Tax Code:
Planning area:
98368-7131
Sewer:
PTSEWER -
Drainage:
Connected(No CWF)
Bank:
View 1:
View 2:
Zoning 1:
Zoning' 2:
Zoning 3:
Sub Division:
9444 - COLUMBIA
Land Use Code:
1100
98368-7131
03/26/2015
Port Townsend (50)
Port Townsend
Taxable
0100
R-II(SF) - Medium Density
Single -Family
Property Description:
COLUMBIA ADDITION BLK 2 LOTS 9 & 10(ALL), 11(S5.5-)
Page 1 of 1
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http://www.co.jefferson.wa.uslassessors/parcellparcelprint.asp?value=944400202 4/27/2015