HomeMy WebLinkAboutSEP1975-00058y� s� ..
SEP'15
903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No.�_�
Port, Angeles SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Court House ��nn
Port Townsend �� '"� F Date 17 /J- e-7- 7j
TEF-FIZIj5S1 MAR,SP-LL 13.
OWNER ADDRESS
'� " " • �'' 9837L- g531PHONE
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DIRECTIONS FOR LOCATING SITE�� ,�.D ►ALT .ft�9 [�
APPLICATION IS HMMY MADE T0: INSTALL NE(+! SYSTEM REPAIR EXISTING SYSTEM
YPE OF BUILaING NO. OF BEDROOMS BASEMENT STrpr. RTZ NAME OF _NST L
DRAINFIELD LENGTH 70 I.IIDTH 3y as DEPTH 3 c #LINES '�P- SEPTIC TANK SIZE tzXI S 7- - r®"a
DRAB! ,A DETAILED PLOT PLAN BEIEW., SEE INSTRUCTIONS. SOIL TYPE 122'
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105 �1 Le
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PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
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PAS OF INSTALLATION SIGNATURE OF APPLICANT
APPROVED DATE � p �INSPECTED BY_tt��,, DATE
SANITARIAN'S CO14MLNTS : -�
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I CLRTIFY TH)4T THIS S TEM 'IAS In7ST��L INT MANNER APPROVED BY THE Ci
HEALTH DEAPRTM��NT .0 DATE
INSTALLERS NAME
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903 East Caroline OLYMPIC HEALTH RISTRICT Permit No. S,
Port Angeles _`ee 'Paid
SEWAGED,ISPQSAL PLRINIT -;APPLICATION
Subm:�tin u 13.,1ate
NAME,� �' > � p � A� �S �-L � y, ADDRESS g ,)� Vc-- AJ, DATEr
LEGAL DESCRIPTION PHONE 1 Z J'
DIRECTIONS -FOR LOCATING SITE 56:�O*IL4D &-a fv i �- j34)e
APiLICATSON IS HEREBY MADE TO: INSTALL NEW SYSTZH REPAIR EX TING SYSTEM
'YPE OF BUILDING.y C-15
NO...A BEDROOMS BASEMENT SITE 6?ZE- NAPS OF INSTALLER .�.
of hole
Pere. No., •1
Pero. No 2
Pere.. No.' 3.
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APPRQX. DATEQFY,:�NSTALLATI I+ SZgnature of Applicant
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Streams or bodies of water' nearbir
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Location of p olation 't64t holef
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10.
Septic tank at,e aO ��. �:,
Slope '!rland
11.
Length of proposeT drainfield
Mater lines"& well(if applicabl ;
12.
Depth to water if encountered.
PRC4�`I'ES'
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of hole
Pere. No., •1
Pero. No 2
Pere.. No.' 3.
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APPRQX. DATEQFY,:�NSTALLATI I+ SZgnature of Applicant
S-�.N1TAR C.ONIN�PN'TS_.
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0006
BUILDING PERMIT APPLICATION B RDOe Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00006 Received Date: 1/6/2003
SITE ADDRESS: 90 JAKEWAY RD
QUILCENE, 98376
OWNER: TRAVIS A HITT PHONE: (360)765-4987
BONNIE K HITT
90 JAKEWAY RD
QUILCENE WA 98376-8542
SUBDIVISION: Block: Lot: 43-44
PARCEL NUMBER: 701184027 Section: 18 Township: 27 N Range: 01 W
CONTRACTOR:
REPRESENTATIVE:
OWNER/BUILDER
PHONE:
PHONE:
PROJECT DESCRIPTIO? FIREWALL BETWEEN EXISTING STRUCTURES
TYPE OF WORK
RES
TYPE OF IMP
NEW
VALUATION
550.00
CODE EDITION:
1997
OCCUPANCY:
1 4 o-3
OCCUPANCY:
Landslide
CONST TYPE:
Aquifer
CONST TYPE:
Rural
SEWAGE DISPOSAL:
WATER SYSTEM:
SQUARE FOOTAGE:
MAIN:
ADD'L:
HEAT BASE:
UNHEATED:
OTHER:
GARAGE:
DECK
BEDROOMS:
BATHROOMS:
Exist:
Exist:
Prop:
Prop:
Total:
Total:
loutinq Date:
1 4 o-3
HEAT TYPE:
HEAT TYPE:
# OF STORIES:
SHORELINE:
SETBACK
BANK HEIGHT.
PARCEL TAGS: YES
NO
STORMWATER: YES
NO AREA
Wetland
Erosion
Seismic
Streams
Flood Way
Floodplain
F&W
Landslide
Shoreline
Aquifer
Forest: Commercial
Rural
Type
Amount Paid
Bv:
Date:
Receipt:
Approved/Date
Permit $38.75 MAM 01/06/03 51542
Plan Check
$25.19
MAM
01/06/03
51542
State Building Code
$4.50
MAM
01/06/03
51542
D3
Total:
$68.44
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