HomeMy WebLinkAboutSEP1972-00023r s M _ L
_: pLYMPIC HEALTH DISTRICT Permit No.
Aag ae Fee Paid $_ /,.e •�
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate
ADDRESS .cdjE,C DATFL.,�
LEGAL DESC1LIPTION.Z.92�
DIRECTIONS'FOR LOCATING
APPLICATION IS HEREBY MADE T0: INSTALL NEW SYSTEMREFAIR EXgS'.0 S$STEM
E Or BUILDING NO. OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLER_
--ON THE REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMAT1i
Iv, r.pi. y . lines 7.
Location of building 8o
,•ocation of septic tank 9•
4.ZLoceti�n of drainfield 10.
dope of land 11.
a Ei► Tres `�' we�:i appi� able) 12.
PERCOLATION TES'
Driveways, patios, carport4 etc.
Streams or bodies of water nearby
Location of percolation test holes
Septic tank size t) ...� gall=
Length of propose- drainfield
Depth to water if encountered."
r RESULTS
LeptA ` Ime required to Yergolation rate Type VA
of hole seep last. 6 in. (divide time by 6)
Pere. Nor
Pi".. No. �
Perc. No. 3.
DRAINFIELD LENGTH 0 WIDTH t{ DEPTHjJ -4S 11e,�eNo. OF LINES
ZT• -IS HEREBY AGREED THAT -THE PROPOSED INSTALLA ION WILL BE MADE IN THE
AS-- DMIGNED AND APPROVED ON THIS APPLICATION. a
of ppli
-APPROX..DATE OF' INSTALLATION `7111 %L Signature cant
SAMITARIAN 93 COMMENTS:
,GONSTITIF,k ERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APL
PLAN _APPROVED DISAPPROVED DATE
DATE_INSPF,CTE��� �� � &,_ � SANITARIAN
REMARKS:
I CERTIFY THAT THIS �-)YSTprt T d4S INSTALLED IN THE X.LNNER APPROVED BY THE r,, Ti h
DEPA.RTPUL'NT . 7 /1 L,
}. SNS ALLiM IS N Dh
G+w
e, 6
Iv, r.pi. y . lines 7.
Location of building 8o
,•ocation of septic tank 9•
4.ZLoceti�n of drainfield 10.
dope of land 11.
a Ei► Tres `�' we�:i appi� able) 12.
PERCOLATION TES'
Driveways, patios, carport4 etc.
Streams or bodies of water nearby
Location of percolation test holes
Septic tank size t) ...� gall=
Length of propose- drainfield
Depth to water if encountered."
r RESULTS
LeptA ` Ime required to Yergolation rate Type VA
of hole seep last. 6 in. (divide time by 6)
Pere. Nor
Pi".. No. �
Perc. No. 3.
DRAINFIELD LENGTH 0 WIDTH t{ DEPTHjJ -4S 11e,�eNo. OF LINES
ZT• -IS HEREBY AGREED THAT -THE PROPOSED INSTALLA ION WILL BE MADE IN THE
AS-- DMIGNED AND APPROVED ON THIS APPLICATION. a
of ppli
-APPROX..DATE OF' INSTALLATION `7111 %L Signature cant
SAMITARIAN 93 COMMENTS:
,GONSTITIF,k ERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APL
PLAN _APPROVED DISAPPROVED DATE
DATE_INSPF,CTE��� �� � &,_ � SANITARIAN
REMARKS:
I CERTIFY THAT THIS �-)YSTprt T d4S INSTALLED IN THE X.LNNER APPROVED BY THE r,, Ti h
DEPA.RTPUL'NT . 7 /1 L,
}. SNS ALLiM IS N Dh
G+w
903 East Caroline OLYMPIC HEALTR DISTRICT Court House
Port Angeles Port Townsend
BUILDING SITE IN,�rECTION APPLICATION
SUi:,R'�,'� .,e�? I •� X1..8 L£ i:H
OWNER Coutu, 0. L, ADD RE S_531 N. Winnifrdd Tacoma DATE -11- 229 -71
i.r.rrr�.r�rr�rw� —�w..
9.
LEGAL DESCRIPTION 07
5 G
DIRECTIONS FOR LOCATING SITE So. Point Road. Mailbox with namee l mi. past turnoff
to So Point Road, Existing buildingvBlack trimmed with white. 2nd lot past Dodge °s.
AN APPLICATION IS HEREBY MADE FOR APPROVAL E OV 1CA
FOR
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
REIGIDENCE x COMMERCIAL BUILDING OTHER
I40. BEDROOMS 2 BASEMENT YesSITE SIZE on*hon.v�
2 a sSbRE OF WATER pressed 11.
ep
TYPE OF SOIL sand - gravel -some clay in DEPTH TO WATER TABLE
D-TIAW A S E'`.PCH in the sp cces$elow� indicating location of building in rel +ion
to other buldings, property lines, well, streams or other bodies of water.,
indicate proposed location of sewage disposal system.
C�
VIv
IllsYf Maw �x - '��`� /�
Date of Site Inspection °3 %ly ,72
Approved'* �� Disapproved -
�' See reverse side. f or, remarks. �- �� \\ °V�"� �-' Ci r�-y \� AN
�S'� •w C, s \v -tea -\,;, -) av e
q`HIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PERNTIT Ia
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.