HomeMy WebLinkAboutSEP1970-00131tFJ Y� r�C3- d .%
qL9 - Qo
3 East Caroline
OLYMPIC HEALTH
DISTRICT Permit
No.
at t Angeles
fi0. OF BEDROOMS
Fee Paid =;,
NAME OF INSTALLER
SEWAGE DISPOSAL P E2M T APPLICATION
..�.�,_..
"7
nT:nm DT,AM r_TVTrrr_ mur
Submit in Dup1.icate
-410 ;L 'I
NAME
ADDRESS3M
rte'' lrtL `
DATE .
LEGAL DESCRIPTION
er4z 1 ir CT.< PCT 1.)--) 5 3
1 7'3a
PHONE
DIRECTIONS FOR LOCATING SITE
out
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM..,..REPA:IR EXISTING SYSTEM
to Property lines --7. Driveways, patios, carportf etc. LP
2. Location of building 8. Streams or bodies of water nearby {p
3„ Location of septic tank 9. Location of percolation test holes v i
4. Location of drainfield 10. Septic tank size gal1024'
. Slope of land 11. Length of proposed drainfield
6. Water lines & well(if applicable) 12. Depth to water if encountered.
I
PERCOLATION TEST RESULTS
Depth Time required to Percolation rate Type of soil 0
of hole se �last 6 in. ( de time by 6)
Perc. No, l Ys
Perc. No. 2
Perc. -No. 3w
i -
DRAINFIELD LENGTH _CO WIDTH-
-... DEPTH NO. OF LINES,,
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
AS DESIGNED AND APPROVED ON THIS APPLICATION,
g
APPROX. DATE _OF INSTALLATION Signature of Applicant ,�
SANITARIAN'S COMMENTS
V'
4 -
THIS CONSTITUTES PE MIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED
PLAN APPROVED _ DISAPPROVED DATE--;—
DATE
ATE,DATE INSPECTED-- % v SANITARIAN
REMARKS:
erre-.-
5-68Li!.
oo
YPE OF BUILDING
fi0. OF BEDROOMS
BASEMENT SITE SIZE
NAME OF INSTALLER
ON THE REVERSE SIDE.
DRAW A nRTA TT.F.n
nT:nm DT,AM r_TVTrrr_ mur
rFT.T.nt.rTMr. TM-MVIMATTn'
to Property lines --7. Driveways, patios, carportf etc. LP
2. Location of building 8. Streams or bodies of water nearby {p
3„ Location of septic tank 9. Location of percolation test holes v i
4. Location of drainfield 10. Septic tank size gal1024'
. Slope of land 11. Length of proposed drainfield
6. Water lines & well(if applicable) 12. Depth to water if encountered.
I
PERCOLATION TEST RESULTS
Depth Time required to Percolation rate Type of soil 0
of hole se �last 6 in. ( de time by 6)
Perc. No, l Ys
Perc. No. 2
Perc. -No. 3w
i -
DRAINFIELD LENGTH _CO WIDTH-
-... DEPTH NO. OF LINES,,
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
AS DESIGNED AND APPROVED ON THIS APPLICATION,
g
APPROX. DATE _OF INSTALLATION Signature of Applicant ,�
SANITARIAN'S COMMENTS
V'
4 -
THIS CONSTITUTES PE MIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED
PLAN APPROVED _ DISAPPROVED DATE--;—
DATE
ATE,DATE INSPECTED-- % v SANITARIAN
REMARKS:
erre-.-
5-68Li!.
oo
SKETCH FLAN ON GRID BELOW
SCALE•• -10 FEET BETWEEN LINES INDICATE NORTH
_90� East Caroline OLYMPIC HEALTH DISTRICT Court House
Fort Angeles Port Townsend.
BUILDING SITE INSPECTION APPLICATION
Submit in Du2licate
et7AI
OWNER �� ./4 f,.!
��r.r.r�a.w�+w+rr. - �ri�+r�rrr♦rrir�.rrr.rrr.�r.r.wwr�..��+w.i�.r�
LEGAL DESCRIPTION
DIRECTIONS FOR LOCATING SITE &a rr •7l "Pe 4XCZ16 74—/
AN APPLICATION IS HER19BY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
ASIDENOECOMMERCIAL BUILDING OTHER
NO. BEDROOMS BASEMENT �S SITE Si /*0,' te3e)-`SOURCE OF WATER ld 0' 1
TYPE OF SOIL bEPIR TO WATER TABLE
-RAW A SKETCH in /he space below indicating location of b ilding in relation
to other buildings, property lines, well, streams or other bodies of water.
Indicate proposed location of sewage disposal system.
00
Date of Site Inspection J- - -7
Approved' Disapproved
* See reverse side for remarks.
APFVN T - S S IGN T
r
Sanitarian
THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT, A SEPARATE PERiIT IS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.