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Home My WebLink AboutSEP1971-00030APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM SY 77 ��,�.s�A�� ®�D 094��P71-134 • uyvya•u iu.a� a: v.r.+v rrya•a.yr•+.v as aria yvr J# s e fvilc 1',y -v r 903 East Caroline OLYMPIC HEALTH DISTRICT Permit No, '7 Port _Angeles Location Fee Paid $ Streams or bodies SEWAGE DISPOSAL P1,412MIT APPLICATION 3. ,Location Submit in Lak2 `rate 9. Location of percolationtestholed 4. Bellevue, W�a-s� 8006 10, NA %. � /-� �� .�� DDRESS_�� ®�5,�- ✓ � DATEE LEGAL DESCRIPTION, j2 ]"' Length of g proposefl PHONE�S� DIRECTIONS FOR LOCATING SITE %�//�.,Es' S pt�Ti�,� Q� iP/yCihrOrtJ O N Ole Depth to water if encountered. APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM SY veptn ITIme required to Percolation rate Type of soil of hole Iseep last 6 in, (divide time by 6) f Perc. No. l Pere. No, 2 Pero. No. 3. DRAINFIELD LENGTH�WIDTH CUA DEPTH Z C -z t NO. OF LINES\. -" T IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER �- AS DESIGNED AND APPROVED ON THIS APPLICATION. _J 01 �t. Signatu a"of'Applicant / APPROX. DATE OF INSTALLATION - ZANITAR�AN IS CO ENTS: �• 3v � �--� � \� �- S �r. A � ` �i � t� +ISS � �� C� PLAN APPROVED S tSAPPROVED DATE DATE INSPECTED Z�( SANITARIAN W REMARKS 5-68 /Z` 0 8") C WI y-/Al0W TQ - -- + • uyvya•u iu.a� a: v.r.+v rrya•a.yr•+.v as aria yvr J# Property lines 7. Driveways, patios, carport, etc. 2. Location of building 8. Streams or bodies of water nearby 3. ,Location of septic tank 9. Location of percolationtestholed 4. Location of drainfield 10, Septic tank size f,� I P P gallous 5. 6, Slope of Waterlines land 11. Length of g proposefl __..fie drainfield & well(if applicable) 12, Depth to water if encountered. PERCOLATION TEST RESULTS veptn ITIme required to Percolation rate Type of soil of hole Iseep last 6 in, (divide time by 6) f Perc. No. l Pere. No, 2 Pero. No. 3. DRAINFIELD LENGTH�WIDTH CUA DEPTH Z C -z t NO. OF LINES\. -" T IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER �- AS DESIGNED AND APPROVED ON THIS APPLICATION. _J 01 �t. Signatu a"of'Applicant / APPROX. DATE OF INSTALLATION - ZANITAR�AN IS CO ENTS: �• 3v � �--� � \� �- S �r. A � ` �i � t� +ISS � �� C� PLAN APPROVED S tSAPPROVED DATE DATE INSPECTED Z�( SANITARIAN W REMARKS 5-68 /Z` 0 8") C WI y-/Al0W TQ Suttmtl to County Treasurer of the ThM form is your receptwhen stamped cc" inw Ittopmtylsl;catw, REAL ESTATE EXCISE TAX by.astdw. Pay by cash or calMM CHAPTER 82.46 RCW cheek to County Treasurer. PLEASE TYPE Wt PRINT CHAPTER 466.61 WAC ,urs .eee..„11` ee, .v t ea .wnaee,en . W .ere ,.s n •ue,u,eu n .ee a,u , v ,y,.er encu. O NEW OWNER'S Name ALL TAX PARCEL NUMBERS PERMANENT ADDRESS FOR ALL PROPERTY street SAME AS #2 on TAX RELATED 993 000 0114,4) CORRESPONDENCE CRY/state ZIP LEGAL DESCRIPTION OF PROPERTY SITUATED IN UNINCORPORATEDJefferSOn COUNTY ❑ OR IN CITY OF Lots 12 and 13, Division 1, Seamount Estates, as per plat recorded in Volume 5 of Plats, page 49, records of Jefferson County, Washington Subject to Covenants, conditions, reservations and restrictions as shown on face of said Plat. Situate in the County of Jefferson, State of Washington. U Is this property currently: YES NO Classified or designated as forest land? Chapter 84.33 RCW ❑ Classified as current use land (open space, farm and agricultural, or timber)? Chapter 84.34 RCW ❑ Exempt from property tax under nonprofit ❑ organization Chapter 84.36 RCW? Receiving special valuation as historic �y property under Chapter 84.26 RCW? ❑ �°9 Type Prop": ❑ land only ❑p land with ssw building. ❑ land sunlit prsviously ,� p land with mobile home used building 9E'E4AX 001.10/tTR7N3 Oli►,RF1�R8E 0 (1) NOTICE OF CONTINUANCE (RCW) 84.39 or RCW 84.34) N the new owner(a) of land that is classified or designated as current use or forest land wish(ea) to continue the classification or designation of such land, the now owner(a) must sign below. R the new owner(a) doles) not desire to continue such classification or designation, all compensating or additional tax calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34.108 shall be due and payable by the seller or transistor at the time of sale. The county assessor must determine If the land transferred qualifies to continue classification or designation and must so indicate below. Signatures do not necessarily mean the land will remain In classification or designation. If It no longer qualities, it will be removed and the compensating taxes will be applied. All new owners must sign. Thi -land ❑ dose ❑ doesnotqusiNy for continuance. DEPUTY ASSES nATa (3) NOTICE OF COMPLIANCE (Chapter 114.28 RCW) It the new owner(-) of property with special valuation as historic property wish(s) to continue this special valuation the now owner(@) must sign below. If the new owners) do(es) not desire to continue such special valuation, all addi- tional tax calculated pursuant to Chapter 84,28 RCW, shall be due and payable by the seller or transferor at the time of sale. (3) OWNER(S) SIGNATURE -Wee following optional questions are requested by RCW 82.46.120 Name Woodro W. Poling and ® Name Roger Lee Cemper and as Elvera S. Poling W mo Judy Marie Cemper Siraat 120 Seamount Drive street 18214 - 118th Ave. S.E. 1 ❑ 8 boating or cooling system? Local 3/ Cft Br,innon WA zip 98320 1 ❑ Cftv Renton state WA 98058 O NEW OWNER'S Name ALL TAX PARCEL NUMBERS PERMANENT ADDRESS FOR ALL PROPERTY street SAME AS #2 on TAX RELATED 993 000 0114,4) CORRESPONDENCE CRY/state ZIP LEGAL DESCRIPTION OF PROPERTY SITUATED IN UNINCORPORATEDJefferSOn COUNTY ❑ OR IN CITY OF Lots 12 and 13, Division 1, Seamount Estates, as per plat recorded in Volume 5 of Plats, page 49, records of Jefferson County, Washington Subject to Covenants, conditions, reservations and restrictions as shown on face of said Plat. Situate in the County of Jefferson, State of Washington. U Is this property currently: YES NO Classified or designated as forest land? Chapter 84.33 RCW ❑ Classified as current use land (open space, farm and agricultural, or timber)? Chapter 84.34 RCW ❑ Exempt from property tax under nonprofit ❑ organization Chapter 84.36 RCW? Receiving special valuation as historic �y property under Chapter 84.26 RCW? ❑ �°9 Type Prop": ❑ land only ❑p land with ssw building. ❑ land sunlit prsviously ,� p land with mobile home used building 9E'E4AX 001.10/tTR7N3 Oli►,RF1�R8E 0 (1) NOTICE OF CONTINUANCE (RCW) 84.39 or RCW 84.34) N the new owner(a) of land that is classified or designated as current use or forest land wish(ea) to continue the classification or designation of such land, the now owner(a) must sign below. R the new owner(a) doles) not desire to continue such classification or designation, all compensating or additional tax calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34.108 shall be due and payable by the seller or transistor at the time of sale. The county assessor must determine If the land transferred qualifies to continue classification or designation and must so indicate below. Signatures do not necessarily mean the land will remain In classification or designation. If It no longer qualities, it will be removed and the compensating taxes will be applied. All new owners must sign. Thi -land ❑ dose ❑ doesnotqusiNy for continuance. DEPUTY ASSES nATa (3) NOTICE OF COMPLIANCE (Chapter 114.28 RCW) It the new owner(-) of property with special valuation as historic property wish(s) to continue this special valuation the now owner(@) must sign below. If the new owners) do(es) not desire to continue such special valuation, all addi- tional tax calculated pursuant to Chapter 84,28 RCW, shall be due and payable by the seller or transferor at the time of sale. (3) OWNER(S) SIGNATURE -Wee following optional questions are requested by RCW 82.46.120 at the time of sale: 72,000.00 .%-Party YES '�. Subject to elderly, disability, or physical improvement 1 ❑ +` exemption? PJ %V. Does building, it any, have a heat pump or solar 1 ❑ 8 boating or cooling system? Local 3/ . Does this conveyance divide a current parcel of land? -6. 1 ❑ Does sale include current crop or merchantable ❑ timber? 1 i Dasoription of personal property if Included in sale (furniture, ap- pliances, etc.) It exemption claimed, explain Type of Document, 4 situ o y Warrant Date of Document November 16, 1990 Grose sale price i/ S 72,000.00 PersgnalProperty(deduct)2J 8 interest corporate affiliates, related parties, trust, receivership or an estate? Taxable Sale Price 8 Excise Tax: State $ 921.60 Local 3/ $ 180.00 Delinquent Interest: 4/State 5 g. Principal use: Local $ 212 Delinquent Penalty:4/State t recreational Total Due S 1,101.60 (SEE 1-5 ON REVERSE SIDE) T AFFIDAVIT I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT (see its on rev ee for penalties I SIGNATURE NAME (print)hd& DATE d PLACE OF SIGNING: N 9 SPECIFY (circle) ntor grantee/grantor's agent/grantee's agent Address of residence or place of business of person signing (specify): NO 9. Does conveyance involve a trade, partial YES NO �7. 2 LTa interest corporate affiliates, related parties, trust, receivership or an estate? 1 ❑ 219 f. Is the grantee acting as a nominee for a third 1 ❑ 21„� 29 paw g. Principal use: 212 1❑ agricultural 2 1 condominium a recreational 29 4 ❑ apt (4+ unite) 5 ❑ industrial6 reeideatial 7 13 commercial 8 ❑ mobile home 9 timber FOR TREASURER'S USE ONLY FOn"t%WV 64-0pp1 3. IVee '11W COUNTY TREASURER `� ii4339 j �� 7