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HomeMy WebLinkAboutSEP2001-00128 Jefferson County Permit Center D LE C r`' _f- y 1 621 Sheridan St., Port Townsend WA 98368 - a,--__t~' 360-379-4450 SEPTIC PERMIT APPLICATION 27 . ! . DEPT JEFFERSON COUNTY PROPERTY OWNER OF COMM . UELOPMENT MAILING ADDRESS /yc)/ 6. ST2F7- .S : AtcRuek4 9&Ode PHONE Area Code I a53 1 833-/1/U`/ SYSTEM DESIGNER Se(>JZL S jj c LEGAL DESCRIPTION: Section /(o I Township ,,,.l j�' Range PARCEL # 969-no o_00 R' Subdivision Name (../20( e.,) 7.3F/l c& Voq c-n Division Block Lots) g SITE LOCATION 7'// C_ri LA LJ 6A R_.a. Zip Code g56,.5 TYPE OF IMPROVEMENT: Residential ,)c Residential ADU Commercial Community TYPE OF WORK: New ,X Redesign Upgrade Repair Partial (tank) (drainfield) Expansion Designate Reserve Area Conventional Alternative X © Oy\ Q Drainfield Length /70 ft. Number of Bedrooms 3 FQ i Trench Width 3 ft. Basement: yes / ars c.oww-eA CND Trench/Bed Depth Ave / V in. Site Size I. / /)L cam` Number of Lines y Previous evaluation: yes / EP Tank size /vo0 gal. Water Source: private x public Soil type 5--4/ (ATTACH SOIL EVAL.) Application Rate , 7 gal./sq.ft./day TYPE OF SYSTEM .P,2 SS1e 'i Ze0 p29),v74-/ ELrf THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES. Signatures _lL 2.4.1 X ri , e C Date 7,=.10/ FOR OFFICE USE ONLY r; � 4Q PARTIAL = - / ,/ /5 A PROVED RENEWED PRESS/TEST 1 14 4 I FINAL i\t (` gtiQ ti . A S B U I LT 141 ) G` 'SAC Y -tl I-•1crOS PUD I1 r/�Mi RENEWED r7rrYll a,,,, ,,,-,e,,,, Vy,,`�tAIA uP3I, Fire District Planning District School District one ''7 Date 7127/61 Fee (300�� Rec # 0-'2„ Sell___Check # — Case # SEP a — t2$ h:\home\pincntr\hlthinfo\permitapp.doc 10/97