HomeMy WebLinkAboutSEP1971-000511 g 333
71--0451
.903 East Caroline OLYMPIC HEALTH DISTRICT Permit No.
Fort-%ngeles Fee Paid # jQ ,60'
SEWAGE DISPOSAL PE2MIT APPLICATION G
Submit in Du]2 -? cate 4
W PV g2j-91/7
AM$. ADDRESS t DATE, 4K 3,q 4
f,EGAL DESCRIPTION
DIRECTIONS FOR LOCATING SITE
;APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM REPAIR EXISTING SYSTEM
IYPE OF BUILDING N0. OF BEDROOMS BASEMENT SITE SIZE I NAME OF INSTALLER
Property lines
Location of building
Location of septic tank
Location of drainfield
Slope of land
Water lines & well(if applicable)
Perc.
No.
Pere.
No.
Pero.
No.
of hole
1
2
7. Driveways, patios, carport, e;c.
8. Streams or bodies of water nearby
9• Location of percolation test holes
10. Septic tank size P allcars
-11. Length of proposed dralinfield
12. Depth to water if encountered.
PERCOLATION TEST RESULTS
required to Percolation rate
last`6-in. (divide time by Q
I
DRAINFIELD LENGTH +^WIDTH DEPTH NO. OF LINES
T IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER!
S DESIGNED AND APPROVED ON THIS APPLICATION.
a
Signature of Applicant C/)
APPROX. DATE OF INSTALLATION_%��_
+ANITARIAN'S COMMENTS:..
PLAN APPROVED
REMARKS:
S 1
�L
U�
DISAPPROVED DATE
SANITARIAN
puts
M1
BUILDING PERMIT APPLICATI
Jefferson County Building Deyartment • County Courthouse . Port Townsend, 11'ash: 9836MRS12WIP
N E FEET
1. LOCATION: propraphrc name S W SIDE OF ROAD
N E ROAD
S W FROM INTERSECTION OF ROAD AND
other specific location or landmark -
LEGAL DESCRIPTION: /�--
r 5ubdwision
Lot Block
e��...... Township Ranpe
11. TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT
New building
0 Addition
0 Alteration
0 Repair, replacement
0 Wrecking
0 Moving (relocation)
0 Foundation only
OWNERSHIP
Private (individual, corporation,
nonprofit institution, etc.)
0 Public (Federal, State or local 90V0
COST
a Cost of improvement........... .
To be installed but not included
in the above cost
a. Electrical ..................
b. Plumbing ..................
c. Heating, air conditioning .....
d. Other (elevator, etc.1..........
• 0 TOTAL COST OF IMPROVEMENT
III. SELECTED CHARACTERISTICS OF
PRINCIPAL TYPE OF FRAME
Masonry (wall bearing)
("Wood Frame
0 Structural steel
0 Reinforced concrete
[] Other — Specify
PRINCIPAL TYPE OF HEATING FUEL
0 Gas
0 Oil
ledfieity
Coal -
0 Other — Specify
IV. IDENTIFICATION -
Name
1.
Owner
2.
3
Architect
The owner of this t
Signature of applicant
1,
PLANNING ARE
APPROVED BY
0
JFJTEN60rr Cr�ut'ssr' I•+EwL
IL
- I
APPROVED BY:
a
-
BUILDING OFFICIAL
BUILDING TYPE
0 Single Family
0 Multi -Family
number of units --
0 Hotel, Motel, Dormitory
number of units
0 Mobile Home
Ocher — pecify
UBC OCCUPANCY GROUP: `t—
MOBILITY
0 New County Resident
'Is this Structure 10 serve the residential
0.r commercial needs of those employed
at either the US. Navy's Trident or
Indian Island Facilities?
0 YES ONO
USE
0 Full-time Residence
0 Second Home: Recreation Cabin, etc.
0 Second Home: Future conversion to
permanent residence
formic cents/ N residential —Describe in detail proposed use of buildings, a g., food
on es
processing plant, machine shop, laundry building at hospital. elementary
school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant.
If use of existing building is being changed. enter proposed uses
rin 7;
r k-71 n - NC
(� 1 i! 2
MING -
a F SEWAGE DISPOSAL
0 Plic or Private
r
❑ Ind:,n I Iseptic lank, v-11
TY OF WATER 9bTPLY
blit or private company
f� Ind "dual (well, cistern)
TYPE OF FIR
TYPE OF MECHANICAL
DIMENSIONS
• Number of Stories .............
•Total square feet of floor area,
all floors, based on exterior
dimensions ...................
• Total land area, sq. ft........... _
NUMBER OF OFF-STREET
PARKING SPACES
Enclosed-_------- :•.
Outdoors -----------------•••-
RESIDENTIAL BUILDINGS ONLY
Number of bedrooms --------
Number of
Full........
_.. __ _--
balhroorns Partial.... _
Mailing Address — Number, street, city and State
and the understgnt agree to conform to all applicable laws.
Address
ZIP code I T.I. No_
, A - -
T SCHOOL DISTRICT WATER DISTRIG7 _
PERMITFEE, ISSUE DATE PERU
S f'
1
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