HomeMy WebLinkAboutSEP1973-00126.r+a13,:te OLDTIC HEALTH DISTRICT Pet'mit NQ. �
Fee
SSWAO DISPOSAL PERMIT APPI T.IDN
- Submit in Duplicate
DIPECTIONS 'FOR LOCATING SITE A ti
t
APPTyI.CAXI IS-•:HERMT, -MADE -T-&: INSTAIJ NEW BY-ST4--REPAn— EXISTM SYSTEM.
E OF BU IlYG NO. ofDBOOMS BASEMENT ST SI7.,E NAME OF INSTALLER
c}N T VE 1�5 S , DRAW A DETAILED PLOT PLAN GIVING HE FOLLO NG INFORMATIC
14-Proverty .lines .. 7. Driveways, patios, carports etc. p�
2. Location of building 8 Streams or bodies of water nearby
3 --Location of Septic, tank 9. Location of percolation test holes
4*-Loc�a.t on of drainfield 10. Septic tank sizee"��1���
%.-Slope of land lle Length of proposed drainfielk
6;-te.r lines & well(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
Depth i®e required
to Percolation rate Type of soi V�
of hole seep last 6 in. (divide time by
-Pere. No ' 1
Pere. No. 2
Perce No. 3. _
DBAINFIELD LENGTH_- ` WIDTH DEPTHa......�. N'0. OF LINES_.
IT --IS - B EREBY AGREED THAT -THE PROPOSED INSTALLATION WILL BE MAD THZ ►elvii�s
AS -SIGNED AND APPROVED ON THIS APPLICATION.
i tune of',Applicant
A~PPRO,L. _ DA, —OF- INGTALLaA'_4N ^ �'
SAi=ARIAN *�S COMMENTS:
%A1lI ..APPROVED`=� `�., ��: DISAPPROVED DATE 5 L2.1
DAM TMPEOTED jP� /', N f- >,
I CERTIFY THAT THIS SYSTM WAS INSTALLED IN THE MANNER APPROVED BY T�M 41T1
DEP.A.RTM'ENT .
INSTALLER I S NAME DATE
ID
-f
0i t.' Caroline OLYMPIC HEALTH DISTRICT Permit No.
• Port Angeles SWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder.
Court House
Port Townsend+ Date 5 /-a-a./73
014M �`� C`, c..,_ -ADDRESS PHONE
DIRECTIONS FOR LOCATING SITE
APPLICATION HEREBY MADE TO: INSTALL NL1a SYSTEM; S REPAIR EXISTING SYSTEM
DRAINFIELD LENGTH ':►IDTfk 5 DEPTH a�#LINES _% SEPTIC TANK SIZE a- 1®� , _
DRAW A DETAILED PLOT PLAN _BELOV . SEE INSTRUCTIONS. SOIL TYPE_���
PEa1IT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARZKUTT
DATE OF INSTALLATION SIGNATURE OF APPLICA
APPROVED DATE 'S 12 7 NSPECTED BY DATE��
SANITARIAN'S COMMENTS: '
I CERTIFY TH_4T THIS SYSTEM '.IAS INSTALLED IN THE MANNER APPROVED BY THE
HEALTH DEAPRTMENT DATE
INSTALLERS NAME
P
I
I
YPE OF,BUILDING
NO. - OF -BEDROOMS
BASEMENT-1-41TE
SIZ NAME --OF INSTA-LLER
DRAINFIELD LENGTH ':►IDTfk 5 DEPTH a�#LINES _% SEPTIC TANK SIZE a- 1®� , _
DRAW A DETAILED PLOT PLAN _BELOV . SEE INSTRUCTIONS. SOIL TYPE_���
PEa1IT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARZKUTT
DATE OF INSTALLATION SIGNATURE OF APPLICA
APPROVED DATE 'S 12 7 NSPECTED BY DATE��
SANITARIAN'S COMMENTS: '
I CERTIFY TH_4T THIS SYSTEM '.IAS INSTALLED IN THE MANNER APPROVED BY THE
HEALTH DEAPRTMENT DATE
INSTALLERS NAME
P
Parcel # 000101342008
Geo Cd 310134201190
S34 T31 R1W
TAX 31 & TL TAX B
Mode' INQUIRI
Nbad Cd 6025
* Taxpayer Cd ROZA 3500 ROZANSKI, JAMES M T/P Chg Dt 8/23/1999
* Title Owner T/P Chg Usr SS
Tax Code 0100 Status TX TAXABLE Land Use 1100 RES -SINGLE
Affidavit 87171 Vol/Page / C/U Code S/C Cd
1 1 R P l 11% n_ f A n 1f%0% A 1 f% f% I- f9 19 rl TL111