HomeMy WebLinkAboutSEP1970-00029#4
Port
903 Fast Caroline OLYMPIC HEAT,7'_i DISTRICT Permit No. o'gar
Port Angeles Fee Paid $
/146 d� SEWAGE DISPOSAL P�;RMITT APi�T�TCATION .
Yv `�i1�
Submit in Du�li mate 6 1 -1 1 ( -Q��
' SI 3ao3
NAME ADDRESS SAO �'" DATE 5 -IL-PQ
LEGAL DESCRIPTION
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DIRECTIONS FOR LOG`ATIIVG SITE j Aj 7 r ,
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APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEMREPAIR EXISTING SYSTEM!
...
x4me required to
Of hole seep last 6 in.
Perc. No, l
Fero, No.
Pero* No. 3.
eercoiation rate
(divide time by b)
s
0-41- W-r-
DRAINFIELD LENGTH WIDTH
3_L DEPTH P— Np. OF LINES
IT IS HEREBY AGREED THAT THE PROPOSED INST LLATION WILL BE MADE IN THE MANNER
AS DESIGNED. AND APPROVED ON THIS A3PPLICATION.
APPROX. DATE OF INSTALLATION Signature of A licant
SANITARIAN'S COMMENTS �
THIS CONSTITUTES A PEE IT yHiEN gEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED
PLAN APPROVED r , 0`h v a
DISAPPROVED DATE
DATE INSPECTED 5"` 1 7 SANITARIAN
REMARKS:
5-68
A46w h`
%3 �(�99
YPE OF BUILDING ATO, OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLER
N
THE REVERSE SI E, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATIO
1#
26
Property lines
Location
7.
Driveways, patios, carportf etc.
5+
of building
Location
8.
Streams or bodies of water nearby
441
of septic tank
Location of drainfield
9.
10:
Location of percolation test holes
Septic tank size 0 gallons
5•
f.
Slope of land
Water lines & well(if
Ile
Length of proposed drainfield
applicable)
12.
Depth to water if encountered.
PERCOLATION
TEST
RESULTS
x4me required to
Of hole seep last 6 in.
Perc. No, l
Fero, No.
Pero* No. 3.
eercoiation rate
(divide time by b)
s
0-41- W-r-
DRAINFIELD LENGTH WIDTH
3_L DEPTH P— Np. OF LINES
IT IS HEREBY AGREED THAT THE PROPOSED INST LLATION WILL BE MADE IN THE MANNER
AS DESIGNED. AND APPROVED ON THIS A3PPLICATION.
APPROX. DATE OF INSTALLATION Signature of A licant
SANITARIAN'S COMMENTS �
THIS CONSTITUTES A PEE IT yHiEN gEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED
PLAN APPROVED r , 0`h v a
DISAPPROVED DATE
DATE INSPECTED 5"` 1 7 SANITARIAN
REMARKS:
5-68
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