HomeMy WebLinkAboutSEP1974-00204903 E. Caroline
Port Angeles
Court House
Port Townsend
OWNED ��r , ADDRESS 10 3114-, 07-- , `d% . PHONE .[gid
DIRECTIONS FOP _LOCATING. SITE.��'� N�
O,YMPIC HEALTH DISTRICT
SEWAGE DISPOSAL PERMIT APPLICATION
' Submit in Duplicate
Permit No.-�
Builder
Date 9
APPLICATION IS Hr2EBY MADE TO INSTALL N34 SYSTEM --REPAIR EXISTING SYSTEM
BASEMENT
DRAINFIELD LENGTHS IIDTH a' DEPTH 30" #LINES,�SEPTIC TANK SIZE \ft�®
DRAW A
a- %e.
a�a�/s6
WWI
PERMIT UNLESS PRIOR APPROVAL OBTAINEDFROMTHE-HEALTHyLJ-L-L Ali DEPARTMENT. I L1rvHL1Lx �r�.� ruin
DATE OF INSTALLATION SIGNATURE OF APPLICAN9;h��. &o-
A' � R � DAA NSPECTED- BY DATE
5 Ap hy
SANITARIAN'S COMMENTS:
z
uj
13
I CERTIFY THAT THIS S TEM ';! ?ST1iLLED IN THE MANNER APPROVED BY THE
HEALTH DEAPR.T tET
DATE (J�
rTARS NAIv `
CUING 1.00.11 l :.1 r'LIL i. i IUctl
'iTownsen
tent n n rt
JrllersonCou�, e t Cou rr Cnurrnousr . Po
NE
I. LOCA ION- V-•P•aertte nam► S 1111 SIDE OF
wE
5 W F ROM IN IIE RSE CT ION OF ROAD AND -
pfrrer saeciffe IYCaston Or tanamara
GAL SCRIPTION:
Lot
'Tax Ni
11. TYPE AND COST OF Fql 1
TYPE OF IMPROVE SWT
KFNew building®�
Add -Sion ,g„)
0 Alteration `( -
O Repair. replacement
O Wrecking
O Moving frelocation)
O Foundation only
OLYNERSHIP
0Private (individual, corporation. -
nonprofit Institution. etc.)
0Public (Federal. State or local godtJ
.aw Ot �tR 3 T r, 1310
O
w An it l�l'�/ ROAD
2 s4plao wis on
BUILDING TYPE
❑Single Family
0 Mulir•Family
number Of units
O Hotel. Mosel. DormrtOry
number Or units
O Mobile Home
NJ Other
UBC OCCUPANCY GROUP:
MOBILITY
O New County Resident
.It this structure to serve TM I"Wenlial
o■ commercial needs of those employed
at either the U.S Navy's Trident or
Indian Island Farilitieliv
O YES ONO
USE
O Full-time Resdenix
O Second Home. Recreation Cabin. CIE -
0 Second pee omaanent residence a me: Future conversion to
COST /OMNI cents/ Nonresidential - Describe in detail proposed use of buildings. e.g-. food
• Cost of improvrment..... - • • • - - • S processing plant. machine shop. laundry building at hospital. elementary
school. secondary school. college. parochial school. parking garage for
To be installed but not included
department score, rental office budding. office a up�oinpgp� use
tna; plant -
in the above cost
If use of existing building is being Changed.
a. Electrical ....--•-.---------
����g=
b. Pluming -------------------
C_
...............''
C Heating. air eondmoning ------
d.
-----d. Other felevator. etc-) -- - - . - - . _ .
• TOTAL COST OF IMPROVEMENT
IlLSELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME
O Masonry (wall bearing)
® Wood Frame
0Stiuclural sleet
O Reinforced concrete
0 Other - Specify
PRINCIPAL TYPE OF HEATING F
O Gas
O Oil
❑ Etectricit
O
Other - Specify
IV. IDENTIFICATION -
Name
1.
Owner
2.
3.
Archt CCI
TYPE OF SEWAGE DISPO
O Publi rate
Individual (septic tank. etc_)
TYPE OF WATER SUPPLY
O Publi private company
Individual (well, cistern)
TYPE OF FIREP
TYPE OF MECHANICAL
DIMENSIONS
•Number of Stories -------------
0 Total
------------•Total square feet of floor area -
all floors, based on exterior
dimensions..'----------------
• Total land area. sq. ft-----------
NUMBER
.-.-------NUMBER OF OFF-STREET
PARKING SPACES
Enclosed ---------
RESIDENTIAL
--.
RESIDENTIAL BUILDINGS ONLY
Number of bedrooms . - - - - - - .... -
Nurrtoer
Mailing Address - Number. street. CITY and State
The owner of this building and the undersigned agree to conform to all applicable laws.
lure d t�psicant / - Address
Panral......
ZIP code
16=00
L
APPlRE111100ri date
1b .-� FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
PLANNING AREA
APPROVED BY kc. C96
SCCN, Ne QIKX\
p Jerrewsoi+Coarurrwr r-1V.t.ti*r Ot►t
IL PERMIT FEE ISSUE DATE 'PE RMITltIUMBER
I APPROVED BY:
S&----------------
S� :
c BUIL DING OFFICIAL rl
,"i
•
aMEr1: 'ERSaX oaumvrw
BLT2LD2NG APP,L2C��PiTTO'N
Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend, WA 98368
206-385-9141
PERMIT #....:BLD92-0524 DATE RECEIVED.:08/07/92
SITE ADDRESS:74 NELSON'S LANDING RD
:PORT TOWNSEND, WA 98368
-----------------------------------------------------------------------------
OWNER.......:MILLETTE HAMON PHONE: 385-1700
MAILING ADDR:74 NELSON'S LANDING RD
:PORT TOWNSEND WA 98368 SS #:
-------------------------------------------------------------------------------
CONTRACTOR..:NO CONTRACTOR PHONE:
MAILING ADDR:
CONTR. LIC #: EXPIRATION DATE: FED I.D.:
ARCHITECT/..: PHONE:
DESIGNER....:
MAILING ADDR:
PARCEL NO... :001174-015 HEAL A'*- -`
LEGAL DESC..:STR 17-30-01 WWM, TAX # BY: DATE:
LOT BLOCK SHO EL S.
BY.: - DATE:
DESCRIPTION -OF -IMPROVEMENT title -elimination ----------15 May -.F� �-�
BUILDING TYPE ...... :T.E BEDROOMS --/BA HROOMS-- MAIN FL...: 0 sf
TYPE OF IMPROVEMENT:NEW EXIST.: 3ST.: 0 ADD'L FL..: O sf
GARAGE/CARPORT.....: PROP..: 0P..:, 0 HTED BSMT.: 0 sf
WOODSTOVE..........: TOTAL.: 3AL.: `O UNHT BSMT.: 0 sf
UBC OCCUPANCY GROUP: SEWAGE DISPTIC CARPORT...: O sf
TYPE OF CONST......: WATER SUPPLY.:PWELL GARAGE — , : 0 sf
UNITS.: --O STORIES:O HEAT TYPES.: DECKS.....: O sf
DIMENSIONS: -------MOBILE HOME=-- -- COMMERCIAL: O sf
FRAME TYPE: MAKE: YR: INDUSTRIAL: 0 sf
EST COST.$: 0 SIZE:BANK HT... :0 ft
PROJ GRP..: 3216 SH SETBACK:O ft
----- �------------------------------------ ------------ ----------------
.
Owner%agant---------------- FEES --------------
SignatuFIA type amount by date recpt
PRMT $ 75.00
Date: _ B.C. $ 4.50
Issued By:
Date:
------------------------------------
$ 79.50 TOTAL
f
:k
:. ❑
❑
3 .
4.
rivewa Y%
major features such as
1
(ravines,seasonal creeks,
,
of --water, bodies.,.- of__wa r,etc-_ )
❑ 5. Septic tank: and. drainfield
_ _ _ I '� , � � I
locatiom,- existing= - or- �
!
;
}
j ..
_�
-------••---�
Proposed, and distance to
closest structure — --- - - - - - - - - --- - - - -
--- -
_ -
6.
T
Sewer lines
W 31s and or water lines -- - -- - ---- - - - -
/
- -
---
---{-
i
I
e
$ .Nei hborin swells within
_ I f
`W 9 Paved_ surfaces (vatios)
nch a als _
one. i qu -
Grid is 'in- 1/4inch squares)
Screen: 01
Parcel # 000001174015 Geo Cd 300117402110
817 T30 R1
TX 24 (W175')
* Taxpayer Cd
* Title Owner
HAMO 1000 HAMON, WAYNE
Mode: INQUIRY
Auto Roll: OFF
Nbad Cd 5340
Loc ID
T/P Chg Dt
T/P Chg Usr
Tax Code 0111 Status TX TAXABLE Land Use 1101 MH-REALW/LND
Affidavit Vol/Page / C/U Code