HomeMy WebLinkAboutSEP1974-00016w
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Port Angeles
OLYMPIC HEALTH DISTRICT
SLNJAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate
SEP '74 - 00J 6
Permit No.
Builder
Court House
Port Townsend �® j Date
OWNED,
DIRECTIONS FOR LOCATING SITE
APPLICATION IS HEREBY MADE TO: INSTALL N34 SYSTEM REPAIR EXISTING SYSTEM
NMOF NLDIN
NO
OF B R00
B nn1_
q SITE7SIZ
NAME F
INSTALLER
DRAINFIELD LENGTH�+.1IDTH_ 2 DEPTH 1 #LINES ; _SEPTIC TANK SIZE
Z�v
ANY CHANGE IN BUILDING OR SP -,AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HLALTH DEPARTMENT.
DATE OF INSTALLATION' SIGNATURE OF APPLICANT%cyj" 0/, �
APPROVED DATE � �/� INSPECTED
SANITARIAN IS COMMENTS: i
I CERTIFY THAT THIS S m ISTI,LLED N THE MANNER APPROVED BY THE
HEALTH DEAFRTM iT 222_ DATE
���
INSTALLERS NAME
Port Towniend, Washington
April 29, 1974
Ms- Sarah Hudson
P. C. Box 263
Fort Blakely, Washington 98110
Re: -SOils evaluation Of 'Lot 51 Blk 3, Div, 2, Cape
George Colony
Dear Ms. Hudson
I have inslApted two soil 199 h9les-On your lot and
be sandy and, gravelly. The Soil is
found the soil to
fioceptable for the installation'bf
a Septic t.and drainfieldo HOVeVOr, prior to issuance
permit and swage disposal permit -I meed •a specific
location and size c�f homeq drive"
of a -building
plot plan noting'
park�ng,, 'Ptc. -
also be . a taked - I -Could then malij a
YOU nldAW Mr.
The. Site, shod
$
Lindsey
for building itio review,
on the{ site
If YOU have an questions Or comments. please contact
this office.
Randall M. Durant, R. S.
District S8,24tarian
RMD/sa
it
"A,
-'" ppN-SITE SEWAGE_ DISPOSAL SURVEY OF
Street Or
I. Location, Lot Size
II. System Owner
Address
Telephone Number
Permit (?) (Previous Owner)
Date Issued
Division Block Lot Landmark Lot Size
Ill. 1 5 /90 x 9f)
III.Installer,
Date Installed 9
Time In -Service (years) �Q
Septic Tank Pumped
YES No HOW
OFTEN
# of Months/Years Residence Occupied?
Average Number of
People Served
Number of Bedrooms
Clothes Washer
YES
NO
Dishwasher
AOL—
YES
Garbage Disposal
YES
N
IV. pe of cover over drainfield. (i.e. grass,,landscaping, etc.)
V. Repairs (when, what, who) Cause of Failure
VI. Comments (Over for Sketch)
VII. Action Taken