HomeMy WebLinkAboutSEP1970-00034"-East Caroline tp OLYMPIC AEALx7�I DISTRICT Permit No.
$ . Angeles Fee Paid
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Dal ,cate
520'7 S tilAi L
� W".
ADDRES DATE, iRAM -
1
LEGAL.
DESC$IPTION� Ch a rch; l l t-; �7 _t , _ �� 1 PHONE �T
DIRECTIONS 'FOR LOCATING SITE Follow. 2rirhtray signsto Coi�ley�tur Tia ems:_ road
:.1.3, oceed. 6 b1ks.,,, white- :tm.lex..: Continue until- past boat .ramp.
blk. from boat ramp. Green with white trim -1 Utorycab'
APPLICATION IS HEREBY MADE TO: INSTAU NEW SySTEftx REPAIR EXISTING SYSTEM.
.�
S�ST_
Cabin.-24� x 8 2 P10 60 x 200 t
E OF BUILDING NO, OF BEDROOMS BASEMENT SITE STZE NAME OF IALLER
--'ON THE REVERS SIDE, DRAW.A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATIOP
I--Prvpertg lines 7. Driveways, , patios t carport* etc.
2. Location
_ of building 8„ Stre4as or bodies of water nearby
...__Location of septic tank 9, Location of percolation test holes
4. -•-Location of drain.field 10, Septic tank size Sallow
�-
°f land 11. Length of proposed d_41rainfieia
6�-mateater lines
& well(if applicable) 12. Depth to water if encountered.
V
PERCOLATION TEST RESULTS
Depth Time required to Percolation rate Type of soil
of hole see last 6 in.
pew• No, 1 P (divide time by 61
`
Pere.. No. 2
Pere, No. 3. �........`..
�
Qj i�RAINFIELD LENGTH WIDTH DEPT$ 2� N0. OF LINES
IT -.IS HEREBY AGREED. THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
A,.3• -.DESIGNED AND APPROVED
^�
ON THIS APPLICATION.
&'L�APPROX...DATE
'cant
OF INSTALLATION Suture of Ap
SA£+iITARIAN'S COMMENTS: ,(
M
nAeJ ,..sFi,/ev rem j _ dbosE d , kOA-.��-
h pYfD�+. kKc� /lf�a.=5:�roa�q 4 I�',•µei� -
`TH1S._CONSTITIITES
O
A PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROV-_U
r
PLAN. APPROVED DISAPPRO ED DATE N L) _7 Q _
\ e x'm C
REMARKS:
��� /7'n
5-68 `-ge
!k����,S�ANIT IAN
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1_2941"4 eaw
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y/ :`�,�es • ,�cr,� u/> -fir '"d .�. �'� 1> 1
OLYMPIC HEALTH DISTRICT pemit No.
Fee Paid.
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate
NARk.=U&tg=,E=&SLX,,.ADDRESS1849..Slat &W. St% t e DATE
LEGAL DESCRIPTION ---c�.nrjnhj1:L Addting Lal 11- PHONE .& 5---,9349
DnEcrrom -FOR 'LOCATING SITE- . F Ugj%way signs to, Coyle a turn on, Hazel, -21, road
.,ppQqqpd. a blks. . turn rt. by long white taLler# Continue until past boat ramp#
APPLICATION IS HEREBY MADE, TO: INSULL NEW SYSTEM X REPAIR EXTSWO SYSTEIL-wo-r
Cablin-24 x . 8 2 NO 60 x 200 fti Self
BUILDING
V OF BUILDING NO. OF BEDROOMS BASEMENT
k!R F No- OF
SITE 815E NAME'OF INSTALLER
ON TIT7 VE SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING -UlFORMA110
3 --Property lines
2* Location
7. Driveways' patiost carports etc*
Of buildi3zg
3•-LOcatiOn
Bo Streams or bodies of water nearby
of septic tank
4--JA>C&tj-OZj
9, Location of percolation test holes
of drainfield
10. Septic tank size gss
allo�"IoPe
—fliello
Of land
lines
Length of proposed diainld6.-Water
& well (3f applicable)
12. Depth to water if encountered.
PERCOLATION
TEST RESULTS
—Depth T,me require
Percolation rate Type of soil
Pere. 'No. of hole Seep last 6 ins
(divide time b y.0
Pere.. No.
-------------
Perc. No. 3.
DRAINFT-FLD LENGTH
--4.WWIDTH--
DEPTH., OF LINES.._.
IT"IS HEREBY A�}REED HAT THE PROPOSED INSTAL TION WILL BE MADE IN THE MANNER
AS -DESIGNED ANDAPPROVEDON
THIS APPLICATION.
APPROX,DATF, OF INSTALLATION ., 1 51
SANITARIAN 18 COMMENTS:
PLAN -APPROVED DISAPPROVED
REMARKS:
4
5-68
DATE
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903 East Caroline OLYMPIC HEALTH DISTRICT
Port Angeles
Court House
Port Townsend
BUILDING SITE INS EJT?ON APPLICATION
Submit in, Pup.'. cca e
OWNER �Lf-STI?0 V1 ADDRESS � ��,� _DATE
LEGAL DESCRIPTION., /p
DIRECTIONS FOR LOCATING SITE 0h wC11PyW-- �. �f a►�,� 33 Ist-5
Ali
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 ✓ COMMERCIAL BUILDING OTHER
NO. BEDROOMS / BASEMENTS SITE SIZE o > =,__�SOURCE OF WATER
TYPE OF SOIL�p�=„ °) ®, n 1414 DEPTH TO WATER TABLE
VUmdings,
in the space below�cating location of building in rels.t' n
property lines, well, streams or other bodies of water.
Indicate proposed location of sewage disposal system.
Waw
Date of Site Inspection. /^ 7- %/
APPLICANT'S SIGNATURE
Approved'14 Disapproved
s
See reverse side for remarks. Sanitarian
THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE Pili=i!_L IS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.