HomeMy WebLinkAboutSEP1971-00071a�4 1`PII1L"i'ITRIG"i'.
Court Mouse, Port Towmend, Washing" OMW
Cara]cixe OLYMFTC HEALTH DISTRICT Permit Na.
Fee Paid /5,6Q
lhaawad, SEWAGE DISPOSAL PERMIT APPLICATION
e? _ Submit in DuplicateI�Ca /QG 7`Y-
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ADDRESS^, -DAT
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LEGAL _DESMON
bIREGTIONS ' FOR LOCATING SITE
APPLICATION IS HERESY MADE T0: INBT&U NEW Zy„=N-�E G SYSTEM
LVS
OF BUILDING NU. OF BEDROOMS BASEMENT SITE -SIZE NAME OF INSTALLER
-- -_- ���••.�. wiJlili arasrn sl LIL" iayya/a+i. L aiVi 1 aM-a. v.,.v ..r. v. - - ----
1.-Property lines ?. Driveways, patios, carport# etc.
.?* Location of building $6 Stream or bodies of water nearby
3'.. -Location, of septic tank 9. Location of percolation to oles
_. 4*-J,ocation of drainfield 10. Septic' tank size / :,. V7
..Slope Of and: P- 11. Length -of proposed drainfield
"ater lines & well(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS
Depth__Time require t
of hole seep last 6 in.
Pere, No*.l
Pere.. No. 2
Pere. No. -
Percolation rate
(divide time by Q
DRAINFIELD LENGTH WIDTH DEPT$ OF
s _ '---
"A5IGNED - AND APPROVED' ON THIS APPLICATION.
Si&aature o pplicant
APPROX.-DATE OF INSTALLATION 4\
SANITARIAN IS COMMENTS:'5 lk
PLAN.-APPROVED"'
ZAN.-APPPO� DISAPPROVED DATE Ib , j.
�SANITARM
REMARKS:�
'O/°g-,
I 'CERTIFY THAT THIS SYST91 WAS INSTALLED IAT THE MANNER ARI ROVED BY THE Rra .fi
DEPARTMJ;NT .
INSTALLER t S NAME DATE --
SKETCRPUN 00
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Screen: 01
Parcel # 000993000059
Geo Cd 250230411441
SEAMOUNT ESTATES DIV 1
LOT 58
* Taxpayer Cd ROGE 1700 ROGERS TRUSTEE, GARY
* Title Owner
Tax Code
0441
Status Tx
TAXABLE
Affidavit
70729
Vol/Page
/
Leaal Doc
SWD 3/29/93
WD 4/5/99
86632
Taxpayer
ROGE1700
Search Ke
Mode' INQUIRI
Auto Roll' OFF
Nbad Cd 1285
TO
Chg
Dt
5/06/1993
TO
Chg
Usr
KELL
Land Use 1100 RES -SINGLE
C/U Code S/C Cd
Amount 0TH
GARY ROGERS TRUSTEE
MICHELLE ROGERS TRUSTEE
K/R/ATKINS-F/C/BURKE
19431 4TH AVE SW
NORMANDY PARK WA 98166-4054