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HomeMy WebLinkAboutSEP1972-00001' O O U NTY PUBLICHEALTH 615 She ridan Street Pbrt Townsend Wa shington 98368 wvm. jef a rs one ou;ntypu btic heaith. org JEROMY R HEWITT MIRANDA HEWITT 201 MAXWELL AVE PORT TOWNSFND WA A83619 RE: Septic System Monitoring Inspection Report SITE ADDRESS: 201 MAXWELL AVE PARCEL # 941500034 CASE #: SOM72 -00001 Dear: JEROMY R HEWITT October 2, 2012 On February 17, 2011 a monitoring inspection was completed on the above referenced property. This inspection found the following item /s of concern that require correction: 1. Risers (access ports) are required on the septic tank over the center lid for pumping and the inlet and outlet of the tank. 2. Roots were observed in the septic tank. This will allow leakage into or out of the tank. This must be corrected and the areas sealed. 3. The top of the septic tank near the lid is broken and must be repaired. The purpose of proper maintenance is so the County, for the benefit and protection of the public's health, is assured by this department that these systems are designed, installed and maintained in a proper manner. We appreciate your prompt attention to this matter. If you should have further questions please contact this office at 385 -9444. The code sections referenced are attached for your information. This letter is intended to serve as formal notice that further approvals may be withheld until this work is completed and approved by Health Department staff. Postponing correction may result in premature failure of the septic system. A permit is required for any repair or modification of an onsite sewage system per Washington Administrative Code 246 -272A and Jefferson County Code 8.15. Sincer ly, 6 - 16yk Environmental Health Specialist Jefferson County Public Health 360 - 385 -9444 c: File, O &M Specialist Code References 8.15.150 OPERATION, MAINTENANCE AND MONITORING (1) Responsibility of Owner(s). The owner of every residence, business, or other place where persons congregate, reside or are employed that is served by an OSS, and each person with access to deposit materials in the OSS shall use, operate, and maintain the system to eliminate the risk to the public associated with improperly treated sewage. Owners' duties are included, without limitation, in the following list: a. They shall comply with the conditions stated on the on -site sewage permit. b. They shall employ an approved pumper to remove the septage from the tank(s) when the level of solids and scum indicates that removal is necessary. The septic tank shall be pumped when the total amount of solids equals or exceeds one - third (1 /3) the volume of the tank. The pump and/or siphon chamber(s) shall be pumped when solids are observed. c. They shall not use water in quantities that exceed the OSS's designed capacity for treatment and disposal. d. They shall not deposit solid, hazardous waste, or chemicals other than household cleaners in the OSS. e. They shall not deposit waste or other material that causes the effluent entering the drainfield to exceed the parameters of residential/household waste strength. £ They shall not build any structure in the OSS area or reserve area without express, prior consent of the Health Officer. g. They shall neither place nor remove fill over the OSS or reserve area without express, prior consent of the Health Officer. h. They shall not pave or place other impervious cover over the OSS or reserve area. L They shall divert drains, such as footing or roof drains away from the area of the OSS. j. They shall comply with inspection requirements in JCC 8.15.150 and WAC 246 -272A k. They shall complete maintenance and repair of the OSS as recommended by the monitoring entity. 1. They should not dispose of excess food waste via a garbage disposal. m. They should not drive, park or store vehicles or equipment over the drainfield or reserve area. n. They should not allow livestock access to the OSS area or reserve area. o. They shall comply with WAC 246 -272A -270. (2) Breach of Owner's Responsibilities. An owner's or occupier's failure to fulfill any of the responsibilities in 8.15.150 (1) shall be a basis for a Notice of Violation and for the Health Officer to decline to issue approval for further development on the parcel. 1\tidemarkl data lformslF_SOM_CorrReq_novio.rpt 10/2/2012 InchW19 #m ALO-1 ilemm on vow Pbt PIM - . I N ��.�i���i.�..%T�ZT- '.��1�1�7a1 t ��l= �l^._* �7► ����- tars.�rs�s���►sw.��.�...,. �- ..�...._. — raw �r d y 7 1 PwaW AWL �itM4t� `Vt a ztp 4P 60 - D N" IS AREA s�-.� RJE PERMIT `rte 1P O"[AOA Gr 11 ov s�. 4PAM69 a t 1 s NOT TO . E g Plot plan submitted by A as a part of a Monitoring inspection Not reviewed or approved by JGPH. , � CK, . F Port HWngs Ave. W. P Vrt Town tX Townsend, A 98M * fir P .,. sen. — Ia- -vooco Pae20€a �, � b Hobert 6,•' n ftL TC -- HEALTH-- DISTRICT - -permit -No ". Fee Paid SZWAGE DISPOSAL PERMIT APPLICATION. Submit in Duplicate p � 7 455we _-0N 1 REVERSE SIDE` DRAW A DETAILED PLOT PLAN GIVING T$E FOLLOWING INFORMAiIc r 1#--Property lines 7. Driveways' patiosr carport* etc. 2.6 Location of building 8,P Streams or bodies of water nearby =1.3+► Location of septic tank g. Location of percolation test hole-• f 4.— Locsauon of drainfield 10. Septic tank size�®0 Sallat' "r' lope of land 11. Length of proposed dram n��d r'r 6�- -Water lines & well(if applicable) 12. Depth to water if encountered.• PERCOLATION TEST. RESULTS Depth Time require to ercolation rate Type of ,eo�., of hole seep last 6 in. (divide time by �- Pere. Now l 2 .`.... ---r iaarc.. No. Pert. No. 3� DRAINFIELD LENGTH WIDTB f DEPTH a4&1 ol'B U No. OF LINES V•• �• - @'•�' _ _ -_IS REREBY AGREED THAT THE PROPOSE INSTALLATION WILL BE MADE IN THE MANNED Gryry AS- - =IGNED AND APPROVED ON THIS APPLICATION. Signature of ppliCant I f - APPROX.• •. DATE OF INSTALLATION SaAMARIAN 98 COMWTS: 11 ►7 ter+ WHEN HEALTH OFFICER'S SIGNATURE'' AeL -ZA= x►� xr ;: ,� PLAN__APPROVED DISAPPROVED DATES ®a Z-- Ds p 'nv � rmFn ate. C��`�c -SANITAR10 REMARKS;. I CERTIFY THAT THIS SYSTAI WAS INSTALLED IN THE KANNER APPROVED .BY TTIE 8141 R' ® DEP,ARTM'ENT. �/I INSTAL l So N � DKTi An s s se E OF BUILDING N N� O BEDROOMS B BASEMENT S S SIZE N NAME OF USTALLER � r 1#--Property lines 7. Driveways' patiosr carport* etc. 2.6 Location of building 8,P Streams or bodies of water nearby =1.3+► Location of septic tank g. Location of percolation test hole-• f 4.— Locsauon of drainfield 10. Septic tank size�®0 Sallat' "r' lope of land 11. Length of proposed dram n��d r'r 6�- -Water lines & well(if applicable) 12. Depth to water if encountered.• PERCOLATION TEST. RESULTS Depth Time require to ercolation rate Type of ,eo�., of hole seep last 6 in. (divide time by �- Pere. Now l 2 .`.... ---r iaarc.. No. Pert. No. 3� DRAINFIELD LENGTH WIDTB f DEPTH a4&1 ol'B U No. OF LINES V•• �• - @'•�' _ _ -_IS REREBY AGREED THAT THE PROPOSE INSTALLATION WILL BE MADE IN THE MANNED Gryry AS- - =IGNED AND APPROVED ON THIS APPLICATION. Signature of ppliCant I f - APPROX.• •. DATE OF INSTALLATION SaAMARIAN 98 COMWTS: 11 ►7 ter+ WHEN HEALTH OFFICER'S SIGNATURE'' AeL -ZA= x►� xr ;: ,� PLAN__APPROVED DISAPPROVED DATES ®a Z-- Ds p 'nv � rmFn ate. C��`�c -SANITAR10 REMARKS;. I CERTIFY THAT THIS SYSTAI WAS INSTALLED IN THE KANNER APPROVED .BY TTIE 8141 R' ® DEP,ARTM'ENT. �/I INSTAL l So N � DKTi ` 1 ` sx�`TCtt` PLAN ©I .dip ' S=..W t� �. a e �II scaz.� i I I Lam' I � I a N H �� z�nzc��V oar i� Il I I�I I II I 4 ij ,. I � !I � l I 'Ill �I IIII III 4 t ' { I. i � CC Z 7 T III4'o z I Ill I ki I - 1 r ', II' 111 Coll �yt li I i IIII�III; �yl I � ICI I� I : �� I �� � �i �G� •C r� !'9t,'�"�' \ �sei�. ! �►CGt I " ll ��� - � ! o IIII II, ���• I I�� • I +l! � �I r I II I 1 ', III �?� ". I �Il�h„ .....�. .,. �,.a. � ._� I! v.� �i I;. •III: I II Itlw,•�III I I,W�F. I �U: � I I i `� , - � I � � I }III- I Ii I li I •I I I II I I I I I II' I I I ll � li I I III l II ih14�l1 I� Ilfilr 'II IIL� I� II II I I I I IJ IIII .Y L i I I II 1 I I I , 4W dli ail I 1; I � � Ili 11 II I: l `III III � IIII II � I� I l III ail 1 I I _ ; I 1 Iii' I I,I t. I A 903 East Caroline Port Angeles OLYMPIC HEALTH DISTRICT BUILDING SITE INSPECTION APPLICATION Submit in Du21icate OWNER LEGAL Court House Port Townsend DIRECTIONS FOR LOCATING SITE �ru�enr�n rirrrilrY•• rrrrr� ir••t�. err. �. rr. rirrawrr. r. Y��. w. .rrr.�rrrr.rrnrr�Y��.�Yrr�.r.r AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM. e �+..�"�"`ti E�e�•erAC bra....•... RESIDE%1C`E °''-- N' COMMERCIAL BUILDING OTHER N0. BEDROOMS i SITE SIZE t SOURCE OF WATER C TYPE OF SCI �\ DEPTH TO WATER TABLE D RAW A SKETCH �l belowr4ndicating location of building in relation to other buildings, property lines, well, streams or other bodies of water. Indicate proposed location of sewage disposal system. 4 ti 70/ PUP Date of Site Inspect L C Approved'i isapprooed * _ Sanitarian 4 See reverse side for remarks. THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PERMIT IS NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD. s dl 903 E. Caroline Fort Angeles, Wa. 98362 457 -8583 802 Sheridan Avenue Port Townsend, Wa. 98368 385 -0722 OLYMPIC HEALTH DISTRICT Date Z /S Applicant: Mr_ Allan H� Waiaalght Name Address .1 A Y No: # -Z'Y-74 Fee: $ _ 5.Q0 Sec.. Twn. RS. P Legal dedcription Id?u 2 ru1 GG�� eP1e Directions for locating site 2Q& Oarnhard WA 98366 Phone: (17-G• Site size This does NOT constitute approval of a Building or Seller Sewage Disposal Permit. Buyer — A site evaluation of the above property has been made on ® Date by this department and your request for_ single family residencel:=-- �other(� has been: I AAPPROVED: .Pending submission of a completed sewage �disposal permit application. CONDITIONALLY APPROVED: Providing conditions listed below are met. DENIED. Soil Lag: Respectfully, District Sanitarian On observing the permit ( 5182 of 8/21/72) and drainfield drawn thereon, I wish to clarify present and future interpretations and alleviate any misunderstandings regarding the existing drainfield. My original request and application for permit was for a future home W bedroom) and it is nov; as well as then,my understanding and that of Mary and Mrs. E. G. Wainwright that this was what we got. (continued on reverse side) )HD 4/77 \ J At the time of construction and prior to building a home we,asked fora drainpipe to be installed in order to utiiizd�a travel trailer that we had then$ not construct x, drainfield of that capacity and size for the end�,use of a.travel trailer or mobil home or whatever we have in the interim period. The purpose of this request is to settle any problems and obtain information necessary in order to begin clearing trees and grading -of'propptr y`preparitory.to construction of a'house and outbuildings. The anticipated home *ill,hav ®'a minimum of two,,bedrooms and a.maximum of. three, approAkAte,aguaie feet will be 1500 to 1600. The location isas drawn on plan with connection made to existing tank. Of,further interest in the fact that the tank area of.dra afield is.. n pure sand of which Mr. &. "Lindsey and s6is can attest to, It is unfortunate you were not able'to observe the closing of field as your. notation on perr;;t that - soil .is,clay and. hardpan would have been amended I'm sure to include the different soil conditions at the head of the field. Of 903 E. Caroline Port Angeles, Wa. 98362 457 -8583 802 Sheridan Avenue Port Townsend, Via. 98368 385 -0722 w • w y T OLYMPIC HEALTH DISTRICT No: # �A Date G Fee: $ 5 -go sec. Twn. Rg. Applicant: T_1r- -4j? are L- Ual, w r aht Lot 3-10 Ulu - :.2, G- P-nrQP 3a_ U l aag Name Legal des criptnipo�n y, R. Q. 9,oX 1, 222 ` r IrSi�rr- r�.r.r. 0 a ell .', /F? .(-- aDa (-J�-QQML p Hij;b ` n s- Address Directions for locating site , Phone:_ gffice:.478=1133 . Site size t A) This does NOT constitute approval of a Building or Seller Sewage Disposal Permit.. Buyer A site evaluation of the above property has been made on r;2 -22 Date by this department and your request fora_ single fa��y�reffience 0 other Ej has been: APPROVED: Pending submission of a completed sewage disposal permit application. CONDITIONALLY APPROVED: Providing conditions listed below are met. DENIED. CO MENTS9 s adequate area for additional drainfiejd if ever =re sQX: Soil Log: Respectfully, District Sanitarian OHD 4/77 COMMUNICI►6LE PUBLIC 0E4TH VIUI fNVINONe4fNTAl HEALTH DISEASECONTROL HIIRSINC STATISTICS HEALTH EDUCATION JE,7ERSON COUNTY HEU M DEPARTMENT _REQUEST FOR FILE INFORMATION Name Address_ Telephone_ Business Business Address Telephone File(s) Requested (Be s=?cific) Reason for Request fA-4A 'a gga ,®lwo"v't-4 i SIGNATURE DATE�� Health Department Use Only Information supplied to rt- ;uesting party Date Supplied Supplied by whom_ Other relevant information a0VVMnS0W OOUWrEW 33UXT-jE)22-TC3 AFFL Jefferson County Planning and Building Departmen Courthouse, 3rd Floor PO Box 1220 Port Townsend, WA 98368 206-385-9141 L L) NOV - M 4 W PERMIT #.... :BLD92-0707 DATE RECEIVED.:11/03/92 SITE ADDRESS:201 MAXWELL AVE :PORT TOWNSEND, WA 98368 -------------------------------------------------------------------------------- OWNER ....... :ROBERT LOID PHONE: 385-7748 MAILING ADDR:201 MAXWELL AVE :PORT TOWNSEND WA 98368 SS #: ------------------------------------------------------------------------------- C.ONTRACTOR..:NO CONTRACTOR PHONE: MAILING ADDR: CONA. LIC #: EXPIRATION DATE: FED I.D.: ------------------------------------------------------------------------------- ARCUITECT/..:DESIGN CONSULTANTS PHONE: 788-1858 DESIGNER.... :PO BOX 1353 MAILING ADDR: :DUVALL WA 98019 --------------------------------------------- --- ---------------- PARCEL NO ... :941500-034 .1 HEAL LEGAL DESC..:STR 18-30-01 WWM, TAX # B DATE: LOT 34 , BLOCK CAPE GEO VIL DIV 7 Syw- S: I I ) DATE B - DATE: DESCRIPTION OF IMPROVEMENT: SINGLE FAMILY RESIDENCE --------------------------------------------------------- BUILDING TYPE ...... :RES BEDROOMS - -- BATHROOMS— MAIN FL...: 1158 sf TYPE OF IMPROVEMENT:NEW EXIST.: 0 EXIST.: 0 ADDIL FL..: 762 sf GARAGE/CARPORT ..... :A PROP..: A. PROP..: 2 HTED BSMT.: 0 sf WOODSTOVE .......... :Y TOTAL.:3,e TP�T 2 UNHT BSMT.: 0 sf UBC OCCUPANCY GROUP:R3 SEWAGE D1S E I CARPORT... : 0 sf TYPE OF CONST ...... WATER SUPPLY.:P TE %,' GARAGE....: 574 sf UNITS.: 1 STORIES:2 HEAT TYPES.:GAS DECKS.....: 0 sf DIMENSIONS: - - - - -- MOBILE M COMMERCIAL: 0 sf FRAME TYPE:WOOD MAKE: YR: INDUSTRIAL: 0 sf EST COST.$: 67300 SIZE: BANK HT... :0 ft PROJ GRP..: 3387 SH SETBACK:0 ft '*! T E ML tC T YR E --------------------------------------------- --------------------------------- Owner /agent -- ---- --------- FEES -------- - - - - -- Signature: t pe amount by date recpt MT $ 495.50 AK 11/03/92 71090 Date: LCK $ 74.33 AK 11/03/92 71090 B.C. $ 4.50 AK 11/03/92 71090 Issued By: Date: (AA --------------------------- $ 574.33 TOTAL I #/z VICINITY MAP ( directions to your property) SAMPLE PLOT PLAN N T PROPERTY BOUNDARIES - ti�r SAP .�L O 'DRIVEWAY / pa of Sc—i ACXS IN Fe-r I PROPOSED BUILDIRS ! LOCATION OF SEPTICI . AND DRAINFIELD - I � Y O LOCATION OF - Tu'P OF BANX <SF APPLICABIsT '� ' JEFFERSON COUNTY UNIVERSAL PLOT PLAN A ND DEVELOPMENT APPLICATION (This is not a permit) Fill in the following information as completely as possible PROPERTY OWNER NAME L \one yr�7 L-O % G j � 6 PHONE DJ ` -7-7 7 MAILING ADDRESS �,;?,0 Max ' -1ye SS# q ZIP [ SEPTIC DESIGNER PHONE MAILING ADDRESS CONTRACTOR (0 k^3 'yN e MAILING ADDRESS S C`t Wye- PHONE STATE LICENSE NUMBER - V"0- .m a G I OBI SA EXPIRATION DATE t �' I [ 9 FEDERAL I .D. NUMBER n���- / ARCHITECT -0C�e,. �J ( 5,% a Y\- QQV- n5 t L c ,ZbC- PHONE HAILING ADDRESS PQ, , LOAN LENDER NAMEAM HOLDER KANE MAILING ADDRESS PHONE SITE ADDRESS: 911 #JROAB9APiE a v PT o w res v.d / ZIP CODE ( ¢� J b LEGAL DESCRIPT.ION: SUBDIVISION NAM'c 0% i10E'i �I�'� LOT�BLOCK DIVISION TAX. NUMBER 9 DIGIT PARCEL NUMBER ` L41 a.A_QC SECTION - TOWNSHIP -- 50 - - -- NORTH - - - -- -RANGE - �`�`u --- - -__WM - DESCRIPTION OF IMPROVEMENT: . PLEASE FILL OUT ALL OF APPLICATION * * ** Dear Property Owner: Please fill this form out as completely as possible. The legal description and 9 digit parcel nLwber may be obtained from your tax statement or from the Assessor's Office in the Jefferson County Courthouse. Please make yourself at least one copy of this form so that you may use it for future development of your property. * * ** Mailing address: Jefferson County Planning &Building Department, PO Box 1220, Port Townsend, WA 98368 r JEFFERSQN; COUNTY ENVIRONMENTAL HEALTH DEPARTMENT -E C . E I V ED Application for Determination og Adeyu,,,ate PPotable Water Su�i8Y9(i 3 1992 Jefferson County Resolution #99. -90 requires building permit .a t*4ry to provide evidence of an adequate potable water supply. nzALTH DEPT. Name R o b rt L. i_._o i Address 3�2a hA Jc_ E v 11 Q� t 9 �eo t /9_- Assessor's Parcel ID# 4-T'' Legal Description of Property�1 Site Address - 2 0 1 YYt cx.w e, \� Av e Type of Structure �t t� Q, 4 Phone /Hm .2-0 6 =1 V7 `l R/ Karr : % Wk 3'95-9131 I Type of Evidence (check one) U v Valid Water Right Permit (attach copy) _ Approved Public Water (attach letter from purveyor that the system is capable of and will supply eater. Include State. TD number. Environmental Health will determine if system is in compliance with State Drinking Water Regulations). Individual Well -- attach copy of: 1) Well logs or pump test result. 2) Lab analysis for water quality parameters: -Total coliform - Nitrate -N 3 ) Plot plan showing location of well with respect to proposed sewage system, buildings, driveways and surrounding properties. THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION. s ignatur. $ Date l o - ° - X1'2 Office Use: a) Water Right Permit # b) Public Water Supply C) Name of Supply e Gea;, no State ID #limp G In.Compliance y s no Individual Well Driller Name Date Drilled Depth, Production Meets Water Quality Standards yes no Application Reviewed by 1, Based .upon the potable wat [ does not me for Determining information prow` ed by the applicant, it . appears that er supply [ meets] (—conditionally meets] :et] the conditions of RCW 19.27.097 and the Guidelines Water Availability for New Buildings. M CAPE.GEORGE COLONY CLUB 61 Cape George Drive Port Townsend, WA 98368 (206) 385 -1177 M E M O R A N D U M RECEIVED NOV 0 31992 jcrt -. .-UUiV I Y HEALTH DEPT. DATE: 10 09 92 TO: JEFFERSON COUNTY RE: Robert L. /Karen Loid ( Legal Owner/s) Lot #34, Division 7, Cape George Village (Highlapq t o t Description) FROM: Property Manager SUBJECT: Cape George Colony Club Public Water System ID #11050C This is to verify that Cape George Colony Club's water system is approved and registered with the State of Washington. We have potable water available per Cape George Water Regulations dated June 30, 1990. WA 4 r L 6 V JEFFERSON COUNTY HEALTH DEPARTMENT k4k CASTLE HILL CENTER • 615 SHERIDAN • PORT TOWNSEND, WA • 98368 t September 22, 1992 KELLY WEST HJ CARROL 2409 JEFFERSON ST PORT TOWNSEND WA 98368 Re: Wainwright - Seller Loid - Buyer Lot 34, Division 7, Cape George Village Dear Ms Kelly: Thank you for your phone call of September 18, 1992. Review of our records indicates that the sewage disposal system on the above referenced property was issued for a two - bedroom residence. This office would have no objection to the construction of a two- bedroom structure provided the system is functioning properly and there remains adequate reserve area for a replacement drainfield. If you have any questions concerning this matter, please feel free to contact this office. Sincerely, (�J Lawrence D. Fay, Jr. Director of Environmental Health LDF f wg (206) 385 -9400 EWRONMENTAL HEALTH (206) 385 -9444 FAX (206) 385 -9401 - -r..,w .[.,' - ;.�,' -+. _? �:•-- .z��.:,lre^^�^�.,ea� -�C:c. �..'; >.., . ' -fit.. _ _ . t,-,- �°'*7r?,..:..??*g'^'�'�"i.`��. JEFFERSON COUNTY BUILDING APPLICATION Jefferson County Permit Center Castle Hill Mall 621 Sheridan St. Port Townsend, WA 98368 360- 379 -4450 PERMIT #..•.:BLD95 -0386 SITE ADDRESS:201 MAXWELL AVE :PORT TOWNSEND, WA 98368 ------------------------------------------------ - - - - -- APPLICANT... :ROBERT LOID MAILING ADDR:201 MAXWELL AVE :PORT TOWNSEND WA 98368 -------------------------- ----------------------- CONTRACTOR..:OWNER MAILING ADDR: DATE RECEIVED.:07 /10/95 PHONE:535 -50 -9031 PHONE: CONTR. LIC #: EXPIRATION DATE: ------------------------------------------------------------------------------- ARCHITECT/..: PHONE: DESIGNER....: MAILING ADDR: ---------------------- PARCEL NO ... :941500034�� ALT: CON : LEGAL DESC..:STR 18 -30 -01 WWM, TAX # BY: _/ DATE: LOT 3 , BLOCK , CAPE GEO VIL�DIV 7 WATER: DATE: CAR DATE: DESCRIPTION OF IMPROVEMENT: ------------------------------------------------------------------------------- Storage building BUILDING TYPE ...... :GAR BEDROOMS - -- BATHROOMS -- MAIN FL...: 0 sf TYPE OF IMPROVEMENT:NEW EXIST.: 0 EXIST.: 0 ADDIL FL..: 0 sf GARAGE/CARPORT ..... :D PROP..: 0 PROP..: 0 HTED BSMT.: 0 sf WOODSTOVE .......... : TOTAL.: 0 TOTAL.: 0 UNHT BSMT.: 0 sf UBC OCCUPANCY GROUP: SEWAGE DISP..:SEPTIC OTHER.....: 0 sf TYPE OF CONST ...... : WATER SUPPLY.: CRPT /GAR..: 1008 sf. UNITS.: 0 STORIES:1 HEAT TYPES.: DECKS.....: 0 sf DIMENSIONS: - - - - - -- MOBILE HOME - - - - -- COMMERCIAL: 0 sf FRAME TYPE:WOOD MAKE: YR: INDUSTRIAL: 0 sf EST COST.$: 2500 SIZE: BANK HT... :0 ft PROD GRP..: 3387 SH SETBACK:O ft ------------------------------------------------------------------------------ Owner /agent ---------- - - - - -- FEES -------- - - - - -- Signature: type amount by date recpt PRMT $ 174.75 MM 07/10/95 109001 Date: PLCK $ 52.43 MM 07/10/95 109001 B.C. $ 4.50 MM 07/10/95 109001 Issued By: Date: ------------------------------------ $ 231.68 TOTAL ;n 6 W CT 3.