HomeMy WebLinkAboutSEP1975-00012a
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...7E.Pi � 91
9�3 E. Caroline OLYMPIC HEALTH DISTRICT
Port Angeles SMIAGE DISPOSAL PERMIT APPLICATION
Submit in. Duplicate
Court House
Port Townsend -'?f IWA
DRESS
DIRECTIONS -FOR LOCATING_:," -ITE vWJ,1, p --
Permit No._�.:s..�.
Builder
Date
PH
APs �-7 e7
APPLICATION IS HERESY MADE TO: INSTALL Nal SMEM REPAIR MMTING SYSTEM
N0. OF BEDROOMS BASFNIENT libsb El SI2
DRAINFIEI,D LENGTH �,JIDTH ' DEPTH, Y #LINES SEPTIC NKK SIZE �.
ANY CHANGE IN BUILDING OR SP AGE DISPOSAL PLANS, LOCATION OR SITE , I ALIDATES TIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
DATE OF INSTALLATION
SIGNATURE OF APPLICANT
5WR ✓'
DATE 'Y_ ,25
INSPECTED BY DAT S
SANITARIAN' S CONMIMTS :
IN THE MANNER APPROVED BY THE
r �1uI\Y1
SITE EVALUATION RECORD
TO: tllr. Frnn-- Burns
Roberts and. KnaM,
Kirv.1ston- W,% - 92346
OLYMPIC HEALTH DISTRICT
Sec. Twn.. . R.
Legal Description
Lot 33, Div. 4
Cape Gc;oKcle Village
I F1 ine and Ridge Road
Site Size, 10#000 + sq* ft* _
Seller
Buyer
Jamieson
C. '-Irat%T-ord
A site evaluation of the above property has been made by this department and your
request for family m -)bile horie, (2 bedroom)
has been Ca7P*7"WV9Td) (conditionally approved) (64' 9-4d).
Comments: 1 3 bzict:r1'100 coil lo-.; holes on LI -15-75. 'soll lo!--, hole ne--3r.
Road is mDrnzl !uteaclay. -4oil loq holes on `N* corn -r of lot is s-3nsatiGfactory
clayIand mot lir,.,j noted. -lill in E
N. . cornr. is smitable soil to 4 ft. - The d -ajn=
ld can 'ne a-pnrovr-d in t1,+!s 1.)c,tion. ifowew-r. the imst end of / I the mr-)bIle home must be
moved south! 21 ft. to gligi:,i for adequate drainfleld are Prior to ar-nroyal of-z-4=rmit,
a specific plot plan ,-,,ust be sub,;iltted on the application for rev ia-
Very truly yours,
Sani ' tarian Rantiall .1. ruxianfq ReZo
District 3an-lf6rian
Date: 4 -IG -75
CC: Nr. Crawford
OHD: U/73
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ON-SITE S€WAGE a'ISPOSAL SURVEY OF
�Street Or
I� Division Block Lot Landmark
I. Location, Lot Size
II. S, stem
Address"
Telephone Number
Permit (?) (Previous Owner)—L
bl to Issued
L.uILL" I,�.0 I L. i—i I r%l , L.IL;�a 0-0r
- Jefferson County Building Department • County Courthouse • Port To►tirlsend, I'Yash. 93368 3851310
N E FEET
1. LOCATION: roymphie name S W SIDE OFROAD
N E ROAD
S W FROM INTERSECTION OF_______.— ROAD AND t
other specific location or landmark:
LEGAL DESCRIPTION: 7 /
1 Lot Subdivision
-Sev`
t 4
Number Y.Section
C
11. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT
0 New building
_
Addition _yr r
-O.
,
0 Alteration'
0 Repair, replace�i{�ant
`] Wrecking
0 Moving (relocation)
,
0 Foundation only
OWNERSHIP
[:]Private individual, corporation,
nonprofit institution, etc.)
❑ Public (Federal, State or local gov'Ll
BUILDING TYPE
0 Single Family
0 Multi -Family
number of units
0 Hotel, Motel, Dormitory
number of units
0 Mobile Home
�[] Other.— Specify ,k
i.
UBC OCCUPANCY GROUP: '
COST (Omit eentsl
• Cost of improvement.. $
To be installed but not included
in the above cost
a. Electrical.......... .....
b. Plumbing ..................
e. Heating, air conditioning ......
d. Other (elevator, etc.)..... . .
• TOTAL COST OF IMPROVEMENT
Ill. SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME
` [D Masonry (wall bearing)
\[�4 Wood Frame
0
Structural steel
G Reinforced concrete
C3 Other — SpecifY --
PRINCIPAL TYPE OF HEATING FUEL
0 Gas
0 Oil
0 Electricity
❑ Coal
0 Other — Specify
IV. IDENTIFICATION -
Name
1.
�'gvner
2.
Contractor
3.
Architect
The owner of this buildi
Signature of applicant
MOBILITY
0 New County Resident
Is this structure to serve the residential
or commercial needs of those employed
at either the US. Navy's Trident or
Indian Island Facilities?
0 YES ONO
USE
0 Full-time Residence
0 Second Home: Recreation Cabin, etc.
0 Second Home: Future conversion to
nermanent residence
Nonresidential — Describe in detail proposed use of buildings, a g., food
processing plant, machine shop, laundry building at hospital, elementary
school, secondary school, college, parochial school, parking garage for
department store,. rental office building, office building at industrial plant.
If use of`existing
fbuilding is being changed, enter proposed use.
fl
TYPE OF SEWAGE DISPOSAL
0 Public or Private
0 Individual (septic tank, etc.)
TYPE OF (NATER SUPPLY
❑ Public o! private tympany
(] Indw'dual (wei+, cistern)
TYPE OF FIREPLACE
TYPE OF N1ECHA?.ICAL
DIMENSIONS
• Number of Stories ............ .
• Total square feet of floor area,
all floors. based on exterior
dimensions ...................
• Total land area, sq. ft.. _ ....... .
NU►19ER OF OFF-STREET
PARKING SPACES
Enclosed ......................
Outdoors...... ...
RESIDENTIAL BUILDINGS ONLY
Number of bedrooms .............
I3umber of
bathrooms
Mailing Address — Number, street, city and State
ng and the undersigned agree to conform to all applicable laws.
Address
Full........
Pa tial.
ZIP code Tel. No.
Application date
PLANNING AREA - FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
apt-,
APPROVED BY:
BUILDING OFFICIAL
SrEo0TFEE
ISSUE DATE RECE I Frr NUMBER
r_o_ '.O /6 C/
P�QT P1AN-date prepared s
c
Ala
FT
t o�
C A 111
Ck
AOR E C?
tit ? Plot plan submitted by
r'#s a part of a Monitoring inspectiotl
d _ lqr-,t reviewed or approved by JCPH.
Pem*# or P'ar+cai # 11716 060 o 3 3 SSP -1 a
_gvWuab n of an K Onsfe Sewage Sy rt 07130!04„pdf page 2 or 5
. . -AKc� -�ol�nng on your pio �
�ProperiyLQ
VYWIS
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& iec
am"Ofa sines
Drdhmm ys and parking spaces
( N!v 9 wtknown)
>x=Noth
p water (E / �)
or"
OVimGr Je-s7
�-
. .garages.etc)
P�QT P1AN-date prepared s
c
Ala
FT
t o�
C A 111
Ck
AOR E C?
tit ? Plot plan submitted by
r'#s a part of a Monitoring inspectiotl
d _ lqr-,t reviewed or approved by JCPH.
Pem*# or P'ar+cai # 11716 060 o 3 3 SSP -1 a
_gvWuab n of an K Onsfe Sewage Sy rt 07130!04„pdf page 2 or 5