HomeMy WebLinkAboutSEP1972-00035H.Hffr,
O TC. fiEA= DISTRICT Fe2 . NO,
Fee Paid. -
SZWAAE DISPOSAL PERMIT APPLICATION
Submit in. Duplicate
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APPLICATION IS HEREBY MADE T0; INSTALL NEW SYSTEM� REFAiR EXIT 5Y93Tb Fk..,,
F BUILDING VO, OF BEDROOMS BASEMENT SITE-BIZE NAME'OF INSTALLER
P HS , DRAW A DETAILED FOLWING FORpATIG
1.-Prope-rty -lines 7. Driveways, patios, carport* etc.
2. Location of building 8. Streams or bodies of water nearby
31- Location of septic tank 9. Location of percolation test holeB
.� Lati on of drainfie „ d, ;:, .......
10.. Septic •tank size 1� �,c.,�.' gallwU
S Tope of inc :, w ".. 11. Length of proposed drainfield
"ater lines & well(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
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of hole
Pere. Now l
Pere.. No. 2
Perc. No. 3.
ame required to Percolation rate IType of so
eep last 6 in. I {divide time by
DBAINFIELD LENGTH i WIDTH.JL�.DEPTH &1- 3�°' NO. OF LINES... r
R.-WHEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
AS— MSIGNED AND APPROVED ON THIS APPLICATION.
! Signature of pp],icant
-APPROS.. -.-DAU OF INSTALLATION ®`�•; .
SANITARIAN
PLAN _.APPROVED DISAPPROVED DATE./L!`&2_
DATE
REMARKS:
I CERTIFY T STE11 vJ S I ` L MANNER APPROVED BY Tp ITE - T-b
DEPARTMENT.
.INSTALLER T"S NAIK2 DATE �-
5 -Ga
903 East Caroline `' OLYMPIC iEALTH DISTRICT
Port Angeles
Court House
Port Townsend
BUILDING SITE INSPECTION APPLICATION
Submit in Duplicate
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OWNER ��" ` ADDRESS l� e r ,' DATE`
rCG�dEi.SL�.....
LEGAL DESCRIPTION_
DIRECTIONS FOR LOCATING SITE e, e& Wl � r /E9
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AN APPLICATI IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
RESIDENCE 5V COMMERCIAL BUILDING f,,g7 V pTHER
NO. BEDROOMSBASEMENT� SITE SI / �4-OSOURCE OF WATER -�
TYPE OF SOIL, �� -1 45�e-a DEPTH TO WATER TABLE iac3 _
DRAW A SKETCH in t e space belowq indicating location of building in relation
to other buildings, property lines, well, streams or other bodies of water.
Indicate proposed location of sewage disposal system.
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L `ti \ \w� _ `5' 1 J� �w �5 .� �� .�Ls . `77
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Date of Site Inspection �! t AP CANTS jSIGNIAM
Approved'4 ✓— pproved
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* See re rse side for remarks.
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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.
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