HomeMy WebLinkAboutSEP1975-000223 E.
Caroline OLYMPIC HEALTH DISTRICT Psrmit No.�n-eyllo* Port Angeleb SEWAGE DISPOSAL PERMIT APPLICATION �,Q�,�za�ae
Submit in Du Iicate Builler�� t,�s
Court Housed ,C i SAID/d 2
Port To�aend�NdMF�S� a, 9 / to _ Date
ADDRESS a PHOie 09 e'- /T z
DIRECTIONS FOR LOCATING SITE%s
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM n_REPAIR EXISTING SYSTEM
E OF BUILDING N0. OF BEDROOMS BASEMENT SITE SIZ NAME OF TNSTAamp
DRAINFIELD 'LENGTH_1jIDTH DEPTH oI�O #LINES o� SEPTIC"TANK SIZE 1-46 0
DRAG. A DETAILED PLOT PLAN BELOW_ SEE TNST-RUCTXON9_ SOi7, TYPE 5,,.k r kC, s,1i-
0
PERMIt UNLESS PRIOR APPROVAL OBTAINED FROM THE HE
DATE OF INSTALIATIONSIGNATURE OF
ASP—ZOR DATEG�75
ISPECTED Bl&
SANITARIANI COMMLNTS:
I CERTIFY THAT THIS
HEALTH DEAPRTMENT V(
1VLM vx OITZ
DEPARTMENT.
IN THE MANNER APPROVED BY THE
SITE EVALUATION RECORD
TO: Peninsula Realty. lr=*
OLYMPIC HEALTH DISTRIM
$6d"
Legal Des,cription
Lot13,� B -1k ,, l0j, Div. 4
303 &Pum= A..�Gei ke
Cat -*-rae Colony
port Town,ead �!A 9,1:*�1,368
Site Size 90 x 140
Seller Leaver
Buyer ZM73-'Ind
A site evaluation of the above property has been made by this department and your
request for si,,gle family residence
has been (+Y (conditionally approved) (MMU.
Comments: 1cspection 4-9-75* Observed two backhoe s,,,Il lo -j holes war the road*
sou coni eras WQre poor to mar-
ginal Tor3.77FUMMMg a 13,7777,17M taxtrc' MT-,, ZT7,17.7flelclo
From prev1i,!:,ii-, expzr1eiico In the area, the :;oil should b� Gotisfactary on the back. of
757e- lot dot-nYhIll boraer.Irg we grTenueite 71TV-1 Me a T?r M'11S 107-M.On tne
site Is approved* Prior to approval of a b-,illding ner-rnit tend swage disposal ,-.c% , ri,,4t
the :,.-,Ite must be. stakod and iplot ? an sub;-Uttea to VITU .,,5TTTcU 75? review.
Very truly yours,
%n
Date: 4-10-75
CC: for buyer enclosed
OFD:11/73
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C/PN-SITE €WAGE DISPOSALSURVEY OF.
JU �®
Street Or
Division Block Lot Landmark
Lot S�'ze
I I . System1Owner
Address) h
�Tel ephol ie Numbe
1_nt Size
Permit M (Pre iious Owner) V ULIS
Date Issued'
IIT. Installer L X Average Number of People Served : s
Date Ihistalled 1 9 7 S Number of Bedrooms
Time In ,Service ,;(years) S XClothes Washer
Y N0.
XSeptic 'tank Pumpj�d /
YES -NO HOW (Dishwasher YES NO
OFTEN
X.# of Molj'�ths/Yeas Residences Occupied? Garbage D-isposal -
E NO
i
II
IV. Type of cover over drainfield. (i.e. grass, landscaping, etc.)
,lil''I II
Y V. Repair$ I(when, w;at, who) Cause of Failure