HomeMy WebLinkAboutSEP1971-00146Zai Caraine OLYMPIC HEALTH DISTRICT Permit No.
,'ark`.-Angelea$ Fee Paid Sit,:Q 3,,,,,...
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate ql_G» l41to
ADDRESS oda DATE
LF�AL ESCRIPTION2 n ��`{� `j� HONE
DTRECTIONS
THIS SYSTEM WAS
FFOO R LOCATING SITE
�S �. � ;,.� ec
,
5ARTMENT .
DATE
-1
INSTALLERIS
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM REPAIR EXIST330 SYSTEM
E OF BUILDING ATO,. OF BEDROOMS BASEMENT -SITE SIZENAME OF INSTALLER
4N THE REVERS, SID , DRAW A DETAILED
PLOT PLAN GIVING HE FOLLOWING INFQRMAlIO
1. -property I -lues
7. Driveways, patios, carports etc.
2. Location of buildi.n,g
80 Streams or bodies of water nearby
3. -_Location, of septic tank
4, -
9, Location of percolation test holes
-L`Ocat].On of drainfield
,.--.Slope
10. Septic tank size „Q C>n,,,�., galls : B
of land
6..--Wat,er lines & well(if applicable)
11, Length of proposed drainfield
12. Depth to water if encountered.
PERCOLATION TEST RESULTS
epth Time required to Percolation rate Type of soil
'r
of hole seep last 6 in.
1
Pere. No.Yere.
(divide time by b),�
No.
-Pert* No.
LRAINFIELD LENGTH � < �
I WIDTH NO. OF LINES �►-�
.,,,,�., DEPTH v'1 /2 _
Ir' --IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNE.R
max -DESIGNED AND APPROVED ON THIS APPLICATION, '
91g ature of Appli ant
APPRDJC...DATE OF INSTALLATT4N '�
SANITARIAN'S COMMENTS;
ALAL`I'H OFFICER'S SIGNATURE APPEARS Ab xrrxv« >.rF
PLAN._APPROVEDa`-, D ISAPPROVED DATE
lit
`7
REMARKS: p.<`_,
IT
I CERTIFY THAT
THIS SYSTEM WAS
INSTALLED
IN THE MANNER APPROVED BY
THE HEALTH
5ARTMENT .
DATE
-1
INSTALLERIS
NAME