HomeMy WebLinkAboutSEP1974-00073Cunti's
Cage .> . OIMWM HEALTH DISTRICT PeTs•it N4. 7 ......
Fee Pari t- . j:.. .
SLVA.QE DISPOSAL PERMIT APPLI ASION
' Stibait in Duplicate
A9 -]"A — as _., . r .9 '1TS A TT'+ � 91 -7 -el
DIRECTIONS "FO R LOCATING SITE a:-J&'dj'
i..
ov
�' R :Y 7 ►+tMML-8ASEMENT
-• --.,� •�. _ ♦w "+rrw .-, w,.e.aia:i � a+.uan n Larm�rr.�aa "" .. +...a .�.• -.— _ —_. — _-
1. Pcrpr,� 13nQs 7. Driveways, patios, carports etc.
2. :Location of building
_ �� •• $, Streams or bodies of water nearby
,3. �La+Gation of }`septic tank C` , 9. Location of percolation test _ hole -s
4.,3fi:on of drainfield 10. Septic tank size ga
-a-� lope of land 1fim
1. Length of proposed drain.eld
.--water 1 n.es & .well(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
Leptn Time required to Yeroolation raze TyFW Vj
`.. of hole seep last 6 in. (divide time by Q
Pers`...No' 1
iera.. No. 2
Perc. Noy 3,;,_ ,_..._..._a
=AINVIE?JD' LENGTgWIDTH ' DEPTH C N0. OF LINES ;.,.
IT--1Z-,HEREBY AGREED THAT TA PROPOSED INSTALLATION LL BE MADE ZN THE MANNER
ASSIGNED AND APPROVED ON THIS AIPPLICATION.
Si tore of 1p ljf6ant
.APPRO�..DATE OF .INSTALLATION
. S0ITA"tS COMMENTS:
U-APPROVED_�DISAPPROVED DATE 1�Dh
REMARKS: _ �.� "�r, =-� w� 5��.°t��.:.�.s�� o,.�,� �a`4;s`•��`
'I CERTIFY THAT THIS SYST121 WAS INSTALLED IN THE MANNER APPROVED BY T" H TI
DEPAHTWT .
INSTALL.Ca S NAME DATE
5_66
7's"
^ef-.eraon
I
COUNTY 1E3U2 LD.= NG
AF'L�L2CA`T20N
County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend, WA 98368
206-385-9141
PERMIT #....:BLD93-0153 DATE RECEIVED.:03/23/9 3
SITE ADDRESS:1163 FOUR CORNERS RD
:PORT TOWNSEND, WA 98368
---------------------------- ------------------------------------------------
OWNER.......:CURTIS KENNEDY PHONE: 385-5521
MAILING ADDR:PO BOX 1169
:PORT TOWNSEND WA 98368
-------------------------------------------------------------------------------
CONTRACTOR..:EASY BUILT SYSTEMS, INC PHONE: 1800-578-3279
MAILING ADDR:1163 FOUR CORNERS RD
:PORT TOWNSEND WA 98368
CONTR. LIC #:EASYB51099OF EXPIRATION DATE:
--- 7---------------------------------------------------------------------------
ARCHITECT/..: PHONE:
DESIGNER....:
MAILING ADDR s A�
I
-------------------------------------------------------------------------------
PARCEL NO...: SEPTIC: 01/L DATE: 1-.15- V
LEGAL DESC..:STR 34-30-01
WWM, TAX #
amount
WATER : DATE:
date
recpt
LOT BLOCK
$
162.00
SHORE��I��S:
03/23/93
77033
PLCK
$
48.60
BY: G-�+-- DATE:
03/23/93
DESCRIPTION OF IMPROVEMENT:
-----------------------------------------------
POLE GARAGE
--------
50- 3-31-93c o
AK
03/23/93
BUILDING TYPE ...... :GAR
BEDROOMS---
BATHROOMS--
MAIN FL...:
0
sf
TYPE OF IMPROVEMENT:NEW
EXIST.: 0
EXIST.: 0
ADDIL FL..:
0
sf
GARAGE/CARPORT.....:
PROP..: 0
PROP—: 0
HTED BSMT.:
0
sf
WOODSTOVE.......... :
TOTAL.: 0
TOTAL.: 0
UNHT BSMT.:
0
sf
UBC OCCUPANCY GROUP:
SEWAGE DISP..:SEPTIC
CARPORT...:
0
sf
TYPE OF CONST......:
WATER SUPPLY.:
GARAGE....:
1440
sf
UNITS.: 1 STORIES:1
HEAT TYPES.:
DECKS.....:
0
sf
DIMENSIONS:
-------MOBILE HOME------
COMMERCIAL:
0
sf
FRAME TYPE:
MAKE:
YR:
INDUSTRIAL:
0
sf
EST COST.$: 14400
SIZE:
BANK HT...:O
ft
PROD' GRP..: 3689
SH SETBACK:O
--------------------
ft
-----------------------------------------
Owner/agent
Signature:
Date: 11,
Issued By:
Date:
FEES
type
amount
by
date
recpt
PRMT
$
162.00
AK
03/23/93
77033
PLCK
$
48.60
AK
03/23/93
77033
B.C.
$
4.50
AK
03/23/93
77033
$ 215.10 TOTAL
3�3
�. ...j -
zm
------ --- -
PLOT PLAN
A
N
K
INDICATE the following information. (8 Q u
Draw to scale. Use 1 square to equal - - -- -:-- -- --- - - R
no more .than ten (10) feet.
Fr
❑ 1. North arrow _- --- -- -- - - --- - --- - A -1
D 2. Property boundaries and dimensions _
❑ 3. Names of adjacent streets — — -- -- -- --- --
❑ 4. Driveway/s --- ------ - - - -- - .- `- ---- -
0 5. Major features such as ravines, m �
seasonal creeks, bodies of water, etc. -- --- - -- --- - - -
❑ 6. Septic tank and drainfield location,
existing or proposed, and distance to
closest structure
❑ 7. Sewer lines -- ---- - - - - -- - - . - -----
D 8. Wells and/or water lines
D 9. Neighboring wells within 150 feet
D 10. Paved surfaces (patios) -
D 11. Structures, existing or proposed,
together with setbacks (distances to Q
-_property boundaries) — - ----- - - - D
D 12. Easements for access or utilities
❑ 13. Arrows showing direction of slope--
i
assume an elevation of 100 feet at one - --- ---- ----- - -- --- -- -- - -- -
1
lot corner and indicate therother lot
corner elevations in relation to it.
For applications adjoining shorelines, : (--
INDICATE: — -- - - - - -------- -=----
00
❑ 14. Ordinary high water mark -- — - - ----- - - - -- — - LA0
❑ 15. Top of bank, if over 10 feet high D
D 16. Slope of bank in degrees '• ----�----.- ---- - -- -- ---
Indicate scale of plot plan:
One inch equals—_ -_ - - - -- --
(Grid is in 1/4 inch squares) 2
- - - -
--- ----- -- -- ---------- b, W� l0
8/92Xky
---------- - is � ,:,.
a
VICINITY MAP
(directions to your property)
SAMPLE PLAT PLAN
N
PROPERTY BOUNDARIES
el
ZAP
¢°
fi+
DRIVEWAY
GOO
e� �aPfR
CIyF
SETBACKS IN FELT rl. PROPOSED BUILDING
O
LourIDN } -
OF SEPTIC
AND
DRAINFIELI
D
O
LOCATION OF
WELL
TOP OF BANK (IF APPLICABLE)
„ IGCIC.
Cr
u, P•_
JEFFERSON COUNTY UNIVERSAL PLOT "PLAN AND DEVELOPMENT APPLICATION
(This is not a permit)
i Fill in the following information as completely as possible
TY:OYNER MAMEC..SRT/S 0he� �t'G/V/VE�7 Si_—O it 9ZPHONE39S S �/
MAILING ADDRESS l f<
CITY/STATE ��i�2IdP
APPLICANT NAME Of different)
���� c�/�%S f/r �v/�/ PHONE
MAILINGADDRESS �� Q - 736Y I/&--?
Mawr ;Wfcj,v5_j5A:-v/;� 9/9 ?93 0",
SEPTIC DESIGNER PHONE-,
MAILING ADDRESS
GENERAL CONTRACTOR 6wsy lower �. ��J���s) %�✓G- ��I � O r �v� lO ad PHONE d�7S 7
MAILING ADDRESS -
STATE LICENSE NUMBER -4457135_1d /Qd /�_ EXPIRATION DATE
ARCHITECT PHONE
MAILING ADDRESS
LOAN LENDER NAME/BOND HOLDER NAME
MAILING ADDRESS PHONE
SITE ADDRESS: ZIP CODE
911#/ROAD NAME
LEGAL DESCRIPTION:
SUBDIVISION NAME LOT BLOCK DIVISION
TAX NUMBER TL #Z 9 DIGIT PARCEL NUMBER �v�41 DZ
SECTION TOWNSHIP NORTH RANGE + WM
DESCRIPTION OF IMPROVEMENT:
---- PLEASE FILL OUT ALL OF APPLICATION.-
Dear
PPLICATION=Dear Property Owner: Please fill this form out as completely as possible. The legal description and 9
digit parcel number may be obtained from your tax statement or from the Assessors office in the Jefferson
! County Courthouse. Please make yourself at least one copy of this form so that you may use it for future
development of your property. ****
Mailing address: Jefferson County Planning & Building Department, PO Box 1220, Port Townsend, WA 9836a