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Home My WebLink AboutSEP1971-00112v Est Caroline -OLYMPIC uurn-7, DISTRICT PerMit No. '0 2r rrkewr� Fee Paid $A-k�zi SLIWE DISPOSAL PERMIT ','APPLICATION Submit in,Duel icute ��'�,ADDRESS DATE APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM ZREPAIR EXZjWG SYSTEM 2- thANG 11 NO* OF BEDROOMS 1. --Property Prope-rty 3.iue,3 Zo Location Of building 3%—Lo-cat'on Of septic tank 4--LocatiOu Of drainfield 5,-ZlOPe Of land 6, -Water 3-ines & W611(if applicable) Pare. No. Pere.. No. P -arc. No. NAME OF INSTALLER .';VNT SITE SIZE A�LLFR G G THE FOLLOWING INFORNATIOi C�IEe wT rivew- 9 patiost carporti, etc 8. Streams or bodies of water nearby 9. Lo"tion of percolation test holes loo Septic tank size W CQ gallons lls Length of proposed drainfield 12# Depth to water if encountered. PERCOLATION TEST RESULTS Depth Time required to Percolation rate; Type of E oil Of hole seep last 6 in. (divide time by o 1.1-sLUIFIELD LENGTH NO. OF LINESV% T, If - HERZQx RuiTHEMM) THAT TPROPOSED. INSTALLATION Wf LL BE VD—EfT THE MAK.NER -, 144 -i -DESIGNED -AND-APPROAM CW A�FPtIdAT'ION. __ j'll A�� -712-h Signatu;e of Applicant -APPROX. .DATE OF INSTALLA-TIONK--��c\,,k SANITARIAN'S COMMENTS: it LTH OFFICER'S SIGNATURE APPMRS A P M—APPRO ZDISAPPROVED DATE k REMARKS: I CERTIFY THAT T WAS INSTALLED IN THE MANNER V4jPrjVT BY THE HEALTT kA* 5.8§PARTMENT-, INSTALLER'S NAME DATE N �GR ID H� CH SLA ON BELOW L SCALE, .- ET sETWE4N I,IN INDICATE -NORTH r i I its r r I � I i irl I II 4 I I I I r I. 'II ! i k` I �F L I I _71 III HA 4 �V �b b i I 1" I I h, I i i I. I e I I I I r III, I 9 i I I i , IIS SII I I. �j I I f I II i �I 1 III I I I � l II II ''IrI.'�. II i I i J 11 I \: 9,03 East Caroline OLYMPIC HEALTH DISTRICT Court House Po Angeles Port Townsend 4 BUILDING SITE INSPECTION APPLICATION Submit in Pu EliGalte ._.. OWNER � � �� ,t,,J\ l S '� C� s� c� DATE,»� 1 ri»� rr� LEGAL DESCRIPTION DIRECTIONS FOR LOCATING SITE AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM. RESIDENCE COMMERCIAL BUILDING OTHER N0. BEDROOMS _$ASEMEN SATE SIZEj&X20 _.U.SOURCE OF WATER w J- -tt TYPE OF SOT -L_51 DEPTH TO WATER TABLES DZRAW A SKETCH in the space below* inditating.location of building in relation to other buildings, property lines, well, streams or other bodies of water. Indicate proposed location of sewage disposal system. e - Ln' i.9 L j /S Date of Site Inspectiom____6 A0 L -r ^�_ PP r� S NATURE Approved* -Disapproved See reverse side for remarks, Sanitarian THIS IS LVOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PER:"JIT IS NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD. Map Output Page 1 of 1 vanvalkenbur , F 1 t , 9213=12 1332M Legend P&ad spm ❑ ls�" 0a 9213=16 D 921332= 2 W=4I 92, J I . k FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Tue Nov 22 14:16:45 2005 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=... 11/22/2005 11 0 w spa REAL ESTATE EXCISE TAX AFFIDAVIT This foam is year tecdpt PLEASE TYPE OR PRINT CHAPIBR 8245 RCW-CHAPITR45"I WAC AM 8011111ed by Cashier. SEE BACK PAGE FORUa ATCOMTTMAauamz S OFFEE (Use F—No.944NIBforRgwftT ofContollbgWisest ofBn&yOwn®sidpto.theDepartmeotofReyerm) THISAFFIDAM WILL NOT BEACCEPM UNLESS ALL AREAS 17 ARE FULLY COMPMM ® LEGAL DESCRUMON OF PROPERTY SITUATED IN ❑ UNWCORPORATEDCOUNTY .X O)t iNCITY OF PAS L,,Alt,t� Street Address (ifprapetty is impmvedl: Is this property currently YES NO Designated as forest land? ❑ Chapter 8433 RCW Ciassifledas wrrenI use land (Open spac %farm ❑ 19 and agricultural, ortimber)l Chapter $434 RCW Exempt from propertytax as a nonprofit ❑ orgmi�ation?. Chapter 84.36 RCW Seller'a Exempt Reg.•No. ------ ---' Eeceiving special valuation as hismnte ❑ 19 property? Chapter 84.26 RCW Property Type. []'land only ❑ land with now building ® land with previously used building ❑ lendwithmobilchome ❑ timberonly ❑ building only Principal Use: ❑ Apt (4+unit) ® residential ❑ timber ❑ agricultural ❑ commercial/mdust dal ❑ other (1) NOTICE OF CONTINUANCE (ItCW MM OR RCW 8434) If the now owner(s) ofland that is designated as forest lander classified as cantent use wish to contmuethe designation orclassification, all new owner(s) must sign below. The county assessor mast then dci&mina ifthe land transfsred continues to qualify and will indicatobelow.Ifthe land no longergaaliSav, it wM be removed and the compensating or additional taxes will be due and payable by the salter ortransfstoratthe time of solo. (RCW 84.33.140 or RCW 84.34.108) Ifthe new owner(s) does not desire to continue such designation or classification, all compensating or additional tax shall be due and payable by the seller ortcaysiat. at the time of sale. (RCW $433.140 or RCW 8434.108). Prior to signing below, you may comact your local County Assessor formore fi fnmation, This land ❑ does ❑ does not qualify for confmnanco. Data DEPUIYASSESSOR (2) NOTICE OF COMPLIANCE (Chapter $4.26 RCW) ,f cite now owners) ofpro�erty with special valuation es historic property wish to continaethia special valuation the nawow�r{s? must ae"trggnn below. Ifthe new owners) do not desiroto continueartch vahmmion, all additional tax oalculatcd pntsoant to Chapter 84 26 ItCW, shall be due and payable by the seller ortransfatot' at the time of sale. (3) OWNER(S) SIGNATURE Description of personal property included in gross selling price, both tangible (eg; f4mitum equipment, etc.) or intangible (or, goodwill, agreement not to compate, etc.) If exemption claimed, list WAC number -4 explanation (If claiming a giftWAC CNNo �s�Suinstruction sk - 6 Explanation ''a�\noc�ltxv�te_ i,trFits{ P�� i�` TypoofDocument Cr�11riC\axw. �AAnA Datc of DocumentyF11 2Ot3\ Gross Selling Price $ Personal Property (deduct) $ Taxable Selling Price Excise Tax: State $ Local $ 'Delinquent Interim State $ Local $ *Delinquent Penalty $ Total Dae $�_� A MINIMUM OF 52.00 IS DUE AS A PROCESSING FEE AND TAX. *SEE INSTRUCTIONS FOR INTEREST AND PENALTIES AFFIDAVIT I Certify Under Penalty of Perjury Under no taws of The State of Washington That The Foregoing Is True And Correct (See ofthis form) Signature of Name (print) J +n 131 Dateammd Placc of Signing: Sisoatme of. /A Data & Place of Signing: Perjuryt Perjury is a class C felony which is punishable by iftodso�t in the data oorrecdonal institutionthan >iveyears, or by a fine in an amount fixed by the court afoot mom then five thousand dollars ($5.000.00 or byboth imprisonment foo CW 9A.20.020 1 . PHIS SPACE-TREASURMVS USE ONLY r� t� 3218 1032:26 4/15/2005 caC�fJ n•2.246 1 03226 REV 84 0001a (04-01.04) (PD 04.01.04) COUNTY TREASURER Assessor Detail Building #1 Parcel Number: 921332009 Building Number Year Built Year Remodeled 1 1970 0 Building Exterior Building Area Building Interior Building Type: HOUSE 1st Floor Area: 925 Int. Walls (Cabin): Building Style: 1 STY 2nd Floor Area: 0 Heat: ELECTRIC BB/WALL Foundation: CONCRETE PERIM. 3rd Floor Area: 0 DBL. 2 STY. Exterior: SIDING/STUCCO (LAP) Loft Area: 270 Floor Cover (1): VINYL Roof Cover:WOOD SHAKE Attic Area: 0 Floor Cover (2): CARPET Total Area: 925 Basement Area: 925 Building Rooms Mobile Home Garage Bedrooms: 3 Make:Type: Detached Full Baths: 1 Model:Area: 720 Half Baths: 0 Length: Exterior: Ply/T1-11 Width: Roof: Metal Year Built: Carport Square Footage: 0 Skirting: Area: 0 1st Addition 2nd Addition Type: CarportType: Area: 480Area: 0 Year Built: 0 Year Built: 0 Exterior: Exterior: Roof: Metal Roof: To view another building associated with this parcel. Select building: 1 3 le,11terstin County Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac Page 1 of 1 http://www.co jefferson.wa.uslassessors/parcellassessordetail.asp?Parcel_NO=921332009 11/22/2005