HomeMy WebLinkAboutSEP1975-00099COO
903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No.�
Port Angeles SEWA(E DISR0SAL PERMIT APPLICATION
Submit in Duplicate B'uildefi
Court House
Port TownsendData
A �12
yi 2
ADDRESS ��c z� e PHONE ,
�.. �.,... .. _....r._.+.. ,.._._,..,�.
3
DIRECTIONS FOR LOCATING. SITE
APPLICATION IS HIREBY MAbE TO: -INSTALL NMI SYSTEM REPAIR EXISTING SYSTEM
DRAINFIEI,D LENGTH �� i,tm EPTH . `1a 7::'LINES 1 SEPTIC TANK SIZ_,049
T)DAW A T1T.`fi1k'rTti+n
s�
r
p
i
A NGE N BUILDING OR SU -'AGE DISPOSAL PLANS, LOCATION OR SITE, .i A AT S7 THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HUALTH DEPARTMENT.
DATE OF INSTALLATION_ SIGNATURE OF APPLICANT.��,�„� Y�
DATE '=20'
PECTED BY �� � ATE _51401A5
-.
SANITARIAN'S COPfflM
I CERTIFY THAT THIS
-T! IN THE MANNP APPROVED BY THE
HEA LTH D
b. ORNMEN00smBUILDING PERMIT APPLICATI
�,ufrf y B01idinF Department • County Courthouse • Port
Jetferloh l N E
L' LOCATION
R UAV E
of landmarl+
JJ fuN: -s(_5
LEGAL DESCRW f — Lot'
-Fr- c()UNly, 4L 4 6?_ -j0 L
6s��°'•F Tax N i
I1. TYPE AND COSI I)F BUILDING
TYPE OF IMPROVtTMENT
❑ New building
`<Addn ion
/❑ Alteration
O Repair, r,plerrtjivnt
0 Wrecking
[D moving (rtlocN!jO�)
❑ Foundation olds
el,nn r,a,r,► S W SIDE OF
N f I+(rM INTE RSEC71ON OF ROAD A
bw � 11 1 c.
OWNERSHIP
o Private bndivttliial, corporation,
nonprofit insfrl" loon• tic.)
l• brats or local goJt.)
❑Public (Fedetl
COST
• Cost o1 imprr ,'nient............
l put not included
To be rnsrallrr
in the above
a. Electrical.
b. Plumbing .............
Conditioning ......
c Heating, cele
d Other Wroolo'• etc.l.. - - - - • - -
• TOTAL COS, nF IMPROVEMENT
ROAD
FEET
ROAD
Block Subdivision
z -w
tier V. Section Semon Township Range
BUILDING TYPE
XSingle Family
0 Multi -Family
number of units
p Hotel, Motel, Dormitory
number of units
❑ Mobile Home
❑ Other — Specify
UBC OCCUPANCY GROUP:
MOBILITY
❑ New County Resident
Is this structure to serve the residential
C,, commercial needs of those employed
at either the U.S. Navy"s Trident of
Indian Island Facihnes?
❑ YES ONO
USE
❑ Full-time Residence
❑ Second Home: Recreation Cabin, etc.
❑ Second Horne: Future conversion to
permanent residence ,
/Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
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 use.
�
t- __-%- = 7AIno Y ;i>^-11
III. SELECTED CHAIIACTERISTICS OF BUILDING -
PRINCIPAL TYPE tit FRAME
Masonry (well Nearing)
Wood France
[IStructural stool
❑ Reinforced CriuCrete
O Other — Spet'"
PRINCIPAL Ill, HEATING FUEL
❑ Gas
❑ Oil
❑ Electricity
0 Coal
D Other - Sprr�lt'
IV. IDENTIFICATIIIN "
ME!
2.
TYPE OF SEWAGE DISPOSAL
Q Public or Private .
Individual (septic tank, etc.)
TYPE OF WATER SUPPLY
Public or private company
110 Individual (well, cistern)
TYPE OF FIREPLACE
TYPE OF MECHANICAL
Q
DIMENSIONS
•NumberofStories-------------
•Total square feet of floor area,
all floors• based on exterior
dimensions -------------------
• Total land area, sq. ft -----------
NUMBER
---.------
NUMBER OF OFF-STREET
PARKING SPACES
Enclosed -------------
Outdoors ---------------------
RESIDENTIAL
---•--
RESIDENTIAL BUILDINGS ONLY
Number of bedrooms ------------
TYPE----------.
Number of
bathrooms
Mailing Address — Number, street• city and State
;7!j
1$
Q.►r•ant0 t..i
3. —7 —
Architect
The owner of this ht111ding and the undersigned agree to conform
/�too�all applicable laws. /�
ripp�Manl d p�,J / ..c..7 / y ♦ (V / f%rr%VIV0
a FIRE DISTRICT
e PLANNING AREA
e APPROVED BY
~ 4EAEA" DEPT
o-sEFwa'rscow PERMIT FEE
n
I APPROVED BY:
At
BUILDING OFFICIAI
At
s
Full........
Partial..... f
ZIP code Tel. No.
SCHOOL DISTRICT WATER DISTRICT
DATE I PERMIT NUMBER
jc t `Cx►I%-
I
1 Z'
Kew uWw"I
20 i
r
Xu�� I cue Qytc.
lLallo..��
tr O S.efrm
r
Screen: 01
Parcel # 000602353011 Geo Cd 260235311440
S35 T26 R2W
TAX 6 & 15
Mode* INQUIRY
Auto Roll: OFF
Nbad Cd 1360
* Taxpayer Cd COOK 1600 COOK, HERBERT W UP Chg Dt
* Title Owner T/P Chg Usr
Tax Code 0440 Status Tx TAXABLE Land Use 9800 SITE IMPS
Affidavit Vol/Page I CIU Code S/C Cd
I 1 A A r- r% fnnna iw I •r- A I