HomeMy WebLinkAboutSEP1970-00119903 East Caroline
Port Angeles
��
OLYMPIC HEAL'i DISTRICT Permit No.
Fee Paid $ SCh e�L
SEWAGE DISPOSAL FLRP4IT APPLICATION
Submit in Duplicate
LEGAL DESCRIPTION 1F ,
DIRECTIONS FOR. gh4KING S TE 2 2I1.I
APPLICATION IS HEREBY MADE TO: INSTALL NEW
D,� �Y7 DATE /.
7
j
WYiYi�l �Mt •EXIST33G
P BUILDING }NO* pF1BED800"ASEMENT SITE SI7.E � NAME OF INSTALLER
1. Property lines
2. Location of building
3. Location of septic tank
4. Location of drainfield
5. Slope of land
6. Water lines & well(if a
of hole
Pere. No. 1
Fere. No, 2
Pero. No. 3.
7. Driveways, patios* carports etc.
8. Streaps or bodies of water nearby;
9. Location of percolation test holes
10. Septi tank size/�]fD gallon.a
ll. Lengt of proposed drainfi.eld
Uo Deuth to water if encountered.
J.
ate Type of -soil
by Q
GRAINFIELD LENGTH
IDT 'i ° ' tl
�p� NO. OF LINES. J'
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
F.S DESIGNED AND APPROVED ON THIS APPLICATION.
APPROX. DATE OF INSTALLATION
SANITARIANIS COMMENTS:
PLAN APPROVED W -
DATE
DATE / — 4-V _1 0
REMARKS: / O
i _ hGs
5-68
w
c
s
SKETCH PLAN ON
SCALE --1O FEET BETWEEN LINES \ �"
INDICATE NORTH
t
903 East Caroline OLYMPIC HEALTH DISTRICT
Port Angeles
BUILDING SITE INSPECTION APPLICATION
Submit in Duplicate
Court House
Port Townsend
OWNER C///, / lll',� I S ADDRESS R Do 130)X 3 I DATE 1-- 7d
LEGAL DESCRIPTION aw0A 2-S-, 3
DIRECTIONS FOR LOCATING S
O i .
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___d _COMMERCIAL BUILDING OTHER
NO. BEDROOMS_2.BASEMENT�SITE SIZESOURCE OF WATER
TYPE OF SOIL �Gy DEPTH TO WATER TABLE
1,•RAW A SKETCH in the space elow* 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.
/tri `�Lf & 'l"�
Date of Site Inspection /" C:�v `-7j%
Approved* _Disapproved *
* See reverse side for remarks.
e4lgti11'11(//
APNT SIGAT
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.