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HomeMy WebLinkAboutSEP1974-00096Jefferson County Permit Center 621 Sheridan St., Port Townsend WA 98368 �'mKAY + 360-379-4450 SEPTIC PERMIT APPLICATION ,EPERMIT CENTER PROPERTY OWNER f vi MAILING ADDRESS '3Z Z O DuC A 3 V S h- O N-0 QT'L 1 ti N v N c,, aA , % a 3*. o PHONE Area Code (60 ) -716 - 31 S6 SYSTEM DESIGNER'�,i"L L \)4cooz LEGAL DESCRIPTION: Section0i Township ZS Range b2, PARCEL # q0 -10710C>-7, Subdivision Name Division Block Lot(s) SITE LOCATION -337-o (�UU S �+ f„p Zip Code TYPE OF IMPROVEMENT: Residential Residential ADU Commercial Community TYPE OF WORK: New Redesign Upgrade Repair Expansion / ' Designate Reserve_ _Area_.__ Conventional V Alternative Number of Bedrooms -2 Basement: yes / Site Size 2 Previous evaluation: yes / no SEP S9 O© Water Source: private public TYPE OF SYSTEM Partial (tank) (drainfield) EklfcJ%r V-/Lxvttili=(CU3 Drainfield Length 100' ft. Trench Width z -" ft. Trench/Bed Depth 301 in. Number of Lines Z Tank size 1Qp0 gal. Soil type (ATTACH SOIL EVAL.) Application Rate��.4ST gal./sq.ft./day THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES. Signature Date '+-10— FOR +-30 FOR OFF/CE USE ONLY PARTIAL APPROVED RENEWED PRESS/TEST ASBUILT PUD RENEWED Fire District Planning District -0— School District 4 Zone \ Dated -9 9 feep 00 Rec # Check # Case #SEF h: \homalpincntr\hkhinfolpemtitapp. doc 10/87 k 703 E. Caroline OLYMPIC HEALTH DISTRICT 1 Permit No. 7510 Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION Submit in Duplicate Buildet Court House Port Townsend / 9,6 Iii r -o lvv�. ate, �F t_j'h/ tR a� e- ADDRESS S rip ;%P �h �f °/ PHONE DIRECTIONS FOR LOCATIRJG SITE *,6 L, AZ APPLICATIONS HTREBY MADE TO: INSTALL KD71 SYSTEM I REPAIR EXISTING SYSTEM OF NO. OF B 3 IRAINFIEJ,D LETJGTHZDTH. DEPTHS #LINES SEPTIC TANK SIZE DRAW A DETAILED _PLOT PLAN BELO11. SEE INSTRUCTIONS. " SOIL TYPE ��\t o tCxj r`16 . 4� e ItQ �r ANY CHANGE IN BUILDING OR S ---AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. DATE OF INSTALLATION SIGNATURE OF APPLICANT j&a4 APFRCViD DATE � . a h INSPECTED BY- AT SANITARIAN'S CO1dgMTS I CERTIFY THAT THIS FM 5?A DTS I,LLED IN HE MANNER APPROVED BY THE HEALTH DEAPRTM�EN , DATE IrJSTA N � OK'd LOCATION MAP SAMPLE PLOT PLAN Distances and setbacks marked in feet. N PROPERTY BOUNDARIES I 4iS r DRIVEWAY , O 9 SETBACKS IN FEET LOCATION OF 1 5 Legal Description Subdivision Name: PROPOSED. BUILDING. �} Township: ZS Range: 0 Z Parcel Size (acres or square footage): LOCATION Property Owner. G t L -Z.7- GRA 144a -1 Phone: hone 3(-0-7%- 60 -' 7%- 3 i S O Mailing Address: 3U5.,f OF SEPTIC Applicant/Occupant: if different from owner Phone: Mang Address: AND Authorized Rep: DRAINFIE Marling Address: General Contractor: Or Manufactured Home Installer: gEsE2ve Phone: Maging Address: TOP OF BANK (IF APPLICABLE) Jetfaw Canty Permit Inter * DeparUnaR of ComnWty Oevela"ni 82131wi1an Street Port Townsend WA 88368 00134460 o��p�QO P �o� ED p0�� RA3cE Project Description: a a Z4-x3L au, -"o O Y LOCATION OF WELL Legal Description Subdivision Name: Jetfaw Canty Permit Inter * DeparUnaR of ComnWty Oevela"ni 82131wi1an Street Port Townsend WA 88368 00134460 o��p�QO P �o� ED p0�� RA3cE Project Description: a a Z4-x3L au, -"o 9 Digit Parcel Identification Number (from your tax statement): Sv Site Address 911#: 53 Z. O Road Name' DV LK44, 3 w k4 Zi Code: Z 0 Legal Description Subdivision Name: Block: Lots Section: 0-7 Township: ZS Range: 0 Z Parcel Size (acres or square footage): Property Owner. G t L -Z.7- GRA 144a -1 Phone: hone 3(-0-7%- 60 -' 7%- 3 i S O Mailing Address: 3U5.,f Applicant/Occupant: if different from owner Phone: Mang Address: Authorized Rep: Phone: Marling Address: General Contractor: Or Manufactured Home Installer: Phone: Maging Address: Contractor's State License Number. Expiration Date: Septic Designer: J E C' \)AC -035 Phone:36o_ 51_ S . Z Making Address: . Z Z 1 C S. Architect:/Engineer. Phone: MaingAddress: Loan Lender/General Contractor's Bond Holder. Phone: Mailing Address: 4/y6 M\home\pincntr\forms\universal plot plan JEFFERSON COUNTY PERMIT CENTER 621 SHERIDAN ST SOIL EVALUATION PORT TOWNSEND WA 98368 (360)379-4450 PROPERTY OWNER G((_ LG:✓1z i Gjr - W SYSTEM DESIGNER -� >= -LN,i L , �,� '} C -o S I LEGAL DESCRIPTION: Section 0-7 Township 2 S Range OZ Parcel # -SQ Z - 07?-" Q), Subdivision Name Division Block Lot(s) Date Logged: 'q--19 -qt q Logged By: �g2(lI L � \�(-G1,,s Include soil textural characteristics and the depths at which significant changes occur. Be sure to include depth where mottling or impermeable layers occur. SOIL LOG #1 " to 6 gin. &t140eLr , SiLi LC)R-m to in. to in. to in. Anticipated water table 76 in.* Roots to -io inches Health Dept. Comments SOIL LOG #3 to in. to in.. to in to in. Anticipated water table_ Roots to Health Dept. Comments in. inches SOIL LOG #5 to in. to in. to in. to in. Anticipated water table in. Roots to inches Health Dept. Comments H: A11.NF0 HLTH1 SO1L. FOM SOIL LOG. #2 3,zowe0 O to 7 Z in.Cozat_ r,�,T �- L to in. to in. to in. Anticipated water table 7Lin. t Roots to co `` inches Health Dept. Comments ✓may SOIL LOG #4 to In. to in. to in. to in. Anticipated water table in. Roots to inches Health Dept. Comments SOIL LOG #6 to In. �C in. to LU to in. Anticipated water table_ Roots to Health Dept. I= IL U-1 M t_® LU w M: rZ C.? H: A11.NF0 HLTH1 SO1L. FOM SOIL LOG. #2 3,zowe0 O to 7 Z in.Cozat_ r,�,T �- L to in. to in. to in. Anticipated water table 7Lin. t Roots to co `` inches Health Dept. Comments ✓may SOIL LOG #4 to In. to in. to in. to in. Anticipated water table in. Roots to inches Health Dept. Comments SOIL LOG #6 to In. to in. to in. to in. Anticipated water table_ Roots to Health Dept. Comments in. inches N 7 +JN, J 't .r &%dV ` Gll j 502072007 GOVT LOT 2(N OF RD) —010-`3.00 a. DUCKASUSil RD. 502072006 TAX 3 3.00 a. 502072005 502072009 TAX 2 34.40 a. 502072004 TAX 1 3.00 a. 523' GOVT LOT 2 RECEIVED MAY _ 31999 J.C. PERMIT CENTER This sketch is provided, without chat for your 502072028 Information. it is not Intended to sho all matters GOVT LOT 3 related to die property Including, but n t limiter! (El /2) N 330, to, area. dimensions, asedi ngpts, sncr or location of boundaries. it is not a menta. rt of, nor 4.92 a_ does it modify, the ctitmWbn d Of poii to which it is atteched. The CompanY Mur for any matter rs;.ed to this skotch. should be made to an accurate sm eference to, tudlor Information. OOYT LOT 3 (5330' OF N660') 502072017 502072023 TAX 26 TAX 27 (UNOV 1. 3.54c. No 502072008 TAX 19 4.50a. GOVT TAX 27 ASSESS 1 19 502072026 TAX 36 5.92 a. Nle. 23 y JEFFERSON COUNTY BUILDING APPLICATION Jefferson County Permit Center Castle Hill Mall 621 Sheridan St. Port Townsend, WA 98368 3 -6(Y -;--379r--4450 PERMIT #....:BLD99-0345 k DATE RECEIVED.:06/10/99 SITE ADDRESS:3320 DUCKABUSH �M A :BRINNON, WA 98320 _jp -------------- -- APPLICANT ... :GILBERT GRAHAM--------PHONE:(360)796-3150-- -MAILING ADDRi3320--DUCKABUSH -RD :BRINNON WA 98320 -------------------------------------------------- -------------------------- CONTRACTOR..:OWNER( PHONE: MAILING ADDR: CONTR. LIC #: EXPIRATION DATE: ARCHITECT/..: PHONE: DESIGNER....: MAILING ADDR: ------------------------------------------------------------------------------- PARCEL NO.:502072007 Landslide -Plat Cond Wetland Flooding LEGAL DESC:STR 07-25-02 W WM Seismic Streams Erosion F & W LOT 2, BLOCK , TAX-# Shoreline Aquifer area - :..Cam._. F-ore_%t: -Ad3 .- 3= DESCRIPTION OF IMPROVEMENT: detached garage ------------------------------------------------------------------------------- BUILDING TYPE ...... :GAR BEDROOMS--=- BATHROOMS-- MAIN FL...: 0 sf TYPE OF IMPROVEMENT:NEW EXIST.: j 167.25 EXIST.: 0 ADD'L FL..: 0 sf GARAGE/CARPORT ..... :D PROP..: I RAC PROP..: 0 HTED BSMT.: 0 sf WOODSTOVE.......... : TOTAL.: 06/10/99 TOTAL.: 0 UNHT BSMT.: 0 sf UBC OCCUPANCY GROUP : - SEWAGE - D -I S P ... COIF OTHER .....: 0 sf TYPE OF CONST......: WATER SUPPLY.: CRPT/GAR..: 864 sf UNITS.: 0 STORIES:1 HEAT.TYPES.: DECKS.....: 0 sf DIMENSIONS: COMMERCIAL: 0 sf FRAME TYPE:WOOD INDUSTRIAL: 0 sf EST COST.$: 8640 BANK HT...: 0 ft PROJ GRP..: 6261 ------------------------------------------------------------------------------ SH SETBACK: 0 ft Owner/agent Signature: Date: Issued By: Date: (bld_appl.txt 4/98) - FEES type amount by date recpt PRMT $ 167.25 RAC 06/10/99 15019 PLCK $ 50.18 RAC 06/10/99 15019 B.C. $ 4.50 RAC 06/10/99 15019 $ 221.93 TOTAL I m N I ca Cl G I i N. 44 34 fit