HomeMy WebLinkAboutSEP1970-00121East Caroline OLYMPIC HEALTH DISTRICT Permit No.
port. Angeles Fee Paid S
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in.Duplicate
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AAPRESS
LEGAL DESCRIPTION ( Z PHO�E
DIRECTIONS FOR LOCATING SITE �� DW *3N.lot C'OItO(o SDIJTiI -0 1rf. w4RNEy
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APPLICATION IS HEREBY MADE TO: INSTa NEW:SYSRENJLREPAIR EXISTING SYSTEM,
-0N TM REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING I14FORMATI0
!•-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 Percolatio test holes
4 --Location of drainfield 10. Septic tank size ro,— galloxa
i. -Slope of land 11. Length of proposed drainfield
6.. Water lines & well(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
Depth Time required to Percolation rate Type of soil
Pert. No. 1
of hole seep last 6 in. (divide time by 61
�
Pero..No. 2
Pere. No. 3.
_..
IN
s
v
DRAINFIELD LENGTH�' `WIDTH ,,V DEPT$ O t,y NO. OF LINES ,,
ITIS $EREBY AGREED HAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNeR
AS DESIGNED AND APPROVED ON THIS APPLICATION. �•
li nt
APPROX. DATE OF INSTALLATION 2-i Signature o pp
SANITARIANIS COMMENTS:
:Tffi&,CONSTITUTES A PERMIT WHEN HEALTE—OFFICERIS SIGNATURE APPEARS AS APPROV.
PLAN. -APPROVED. DISAPPROVED DATE "L-7
DATE INS0PECTED SANITARIAN 0
REMARKS:
5-68
EOF BUILDING HO, OF BEDROOMS
BASEMENT
SITE 8 ZE
INAME OF�INSTALLER�
-0N TM REVERSE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING I14FORMATI0
!•-Property lines 7. Driveways, patios, carport, etc.
2. Location of building 8. Streams or bodies of water nearby
3« -,Location of septic tank 9. Location of Percolatio test holes
4 --Location of drainfield 10. Septic tank size ro,— galloxa
i. -Slope of land 11. Length of proposed drainfield
6.. Water lines & well(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
Depth Time required to Percolation rate Type of soil
Pert. No. 1
of hole seep last 6 in. (divide time by 61
�
Pero..No. 2
Pere. No. 3.
_..
IN
s
v
DRAINFIELD LENGTH�' `WIDTH ,,V DEPT$ O t,y NO. OF LINES ,,
ITIS $EREBY AGREED HAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNeR
AS DESIGNED AND APPROVED ON THIS APPLICATION. �•
li nt
APPROX. DATE OF INSTALLATION 2-i Signature o pp
SANITARIANIS COMMENTS:
:Tffi&,CONSTITUTES A PERMIT WHEN HEALTE—OFFICERIS SIGNATURE APPEARS AS APPROV.
PLAN. -APPROVED. DISAPPROVED DATE "L-7
DATE INS0PECTED SANITARIAN 0
REMARKS:
5-68
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