HomeMy WebLinkAboutSEP1975-00110e Wall?&
903 E. Caroline OLYMPIC HEALTH. DISTRICT
Port Angeles SRIXGE DISPOSAL PERMIT APPLICATION
Court House
Port Trownsend,
Permit NO 6,
Submit in Duplicate Builder
ry-.. Late" //7
DIRECTIONS FOR LOCATING SITE,
APPCATION IS HMMY MADE T0: INSTALL\
L-16AIR EXISTING SYSTEM_
OF
YPE BUILD
N0. o�F BEDRooMsBASEMENT
SITE SW OF. INSTALLER
DRAINFIELD LENGTHSDEPTH �O� #LINM 6A S IC TANK SIZE`
DRAM A DETAILED PLOT PLAN BELOW,, SEE INSTRUCTIONS, SOIL TYPE � Y
;C,
as y ++rsa.w —7-- ` w.i. —l'
UNLESS PRIER APPROVAL.OBTAINED FROM THE HEALTH DEPARTMENT.
DATE OF INSTALLATION SIGNATURE OF APPLICANT
APPROM_ DATE I SPECTID BYE A� DAT 02
SANITARIAN'S C011MENTS :
7t3
IERTIFY THAT T
HIS FSYST AS TAL MANNER APPROVED BY THE
HEAITH DEAPRTM VT
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Jefferson. County Planning and Ruildinor Department
Courthouse, 3.rd Floor
JEFF. CouNTv, PO Box 1.220
HEALTHDF?T, Port Townsend, WA 918368
206-38.5-9141
PFRMTT *....:RT,,D90-0372.
DATE RECFTVEn.:05/31/90
,SITE ADDRESS:30 SECOND ST
:PORT HADLOCK,
---------------------------
WA 98339
OWNER ....... :WAYNF.FT.DRTDG'E:.
7 ---------------------------------------------------
PHONE: 385-0342
MATT.TNG ADDR:20 S SECOND
:PORT HADLOCK WA
98339
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CONTRACTOR..:NO CONTRACTOR,
PHONE:
MATL.T.NG ADDR:
CONTR. LTC #: EXPTR.ATTON
DATE:
-------------------------------------------------------------------------------
AR.t;HTTECT/..:
PHONE:
DESTGNF.R..... :
MATT..TNG AnDR!
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PARCET, NO ... :986401004
HEALTH:
LEGAL DFSC..:STR,()Z„-2Q-01
WWM, TAX #
BY: DATE:
LOT 5,6, BLOCK 10 ,
SHORELTNFS:
BY: DATE:
DESCRTPTTON OF TMPROVEMENT:
--------------------------------------------------------------------------_-----
mobile home
BUTLDTNG TYPE ...... :RES
BEDROOMS---
BATHROOMS=-
MATN FL...:
0
sf
TYPE OF TMPROVEMF,NT:NEW
FXTST.: 0
EXTST.: 0
2ND FL....:
0
sf
GARAGE/CARPORT.....:
PROP..: 2
PROP:,: 1.
3RD FT,....:
0
sf
WOODSTOVF.......... :
TOTAL.: 2
TOTAL.: 1'
BASEMENT — :
0
sf
TIBC OCCUPANCY GROTTP:R3
SEWAGE DTSP..:SEPTTC
CARPORT...:
0
sf
TYPE OF CONST......:
WATER SUPPLY.:PUBT,TC
GARAGE..:,.:
0
sf
TTNTTS.: 0 STORTES:
HEAT TYPES,:F.BR/ /
DECKS.,....:
0
sf
DT.MFNSTONS :
-------MOBTLE HOME.--�----
COMMERC`LAT.:
0
sf
FRAME. TYPF:STEL
MAKF:ARDMORE
YR:9O
TNDTTSTRTAL:
0
sf
FST COST.$: 26000
ST.7.F!40 X 24
RANK WT—:
ft
PROD GRP—: 548
------------------------------------------------------------
SH SETBACK:
ft
Owner/agpnt
----------------
------------------
FEES --------------
S i onature :
type amcnrnt
by date
rerpt
PRMT $
75.00 AK 05/31/90
4581.0
Date:54 I I)
1�
R.C. $
4.50 ATS 05/31/90
45810
Tssufa_d R
Date:
-----=---=----- ---------------------
pe'm, Dtp�- $ 79.50 TOTAL
A- �__ L -e -
f ol �v
rA-t
/6 v'
a A// V- ST
4
JEFE COUNTY
HEALTHDEpT
a
cl
(l
/6 v'
a A// V- ST
4
JEFE COUNTY
HEALTHDEpT
Screen: 01
Parcel # 000986401004 Geo Cd 290102204211
PHILLIPS ADDN TO IRONDALE
BLK 10 LOTS 5 & 6
Mode: INQUIRY
Auto Roll' OFF
Nbad Cd 4212
* Taxpayer Cd -ELDR 4500 ELDRIDGE, WAYNE E T/P Chg Dt
* Title Owner T/P Chg Usr
Tax Code 0211 Status Tx TAXABLE Land Use 1101 MH-REALW/LND
Affidavit Vol/Page / C/U Code S/C Cd B
1 1 A A 1