HomeMy WebLinkAboutSEP2013-00008 - 01 APPLICATION I
'c Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368,(360)379-4450
• SEPTIC PERMIT APPLICATION
PROPERTY OWNER John Cowdery Trustee /A,,�
MAILING ADDRESS 21 Greenway Dr. 2¢ ?413
Walnut Creek,CA 94596
PHONE (925)351-3702
SYSTEM DESIGNER: Michael S.Deeney Designer Phone#: ( 800 ) 395-7296 a
LEGAL DESCRIPTION: Section 22 Township 27 Range 1W PARCEL#701224005&701224021
Subdivision Name"Young Parcel"V.26 of Surveys P.95 Division Block Lot(s) 5
Site addresslDlrectlons to site 1425 Camp Discovery Rd.,Quilcane(call owner for gate code)
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential X New Tanks(s)only Private X •
Residential ADU Modification Public
Commercial Expansion
• Community Upgrade X •
Repair SITE SIZE 1.8 acres
SYSTEM TYPE Partial Repair-(tank) (drainfield) Previous Evaluation
Conventional Designate Reserve Area Yes#ZON10-8. '
Alternative X Redesign No
SYSTEM DETAILS
Number of Gallons/day 360 Soil type 4 (attach soil eval.) Application Rate 0.6 gal./sq.ft./day
. Drainfield Length 120 ft. Drainfield Width 3 ft. Drainfield Depth 18 to 36 in.
• Septic Tank size 1,000 gal. Pump Chamber size 1,000 gal.
TYPE OF SYSTEM Reduced Size Pressure Drainfield (NOI)
By signing the application form,the applicant/owner attests that the Information provided herein Is true and correct to the best of
their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this
application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson
County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against
Jefferson County as a result of or in consequence of the granting of this permit I further agree to provide access and right of entry
to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later
inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the
application that he or she requires prior notice. Inspections shall occur during regular business hours. Initial here if you require
notification before entry . Appeal - A person aggrieved of a decision of the Health Officer may appeal.
Appeals shall be submitted to the Health Division in writing within fifteen days after receiving written notice of the decision.
DISCLAIMER-This application Is for an on-site sewage system that meets the state and county
standards in effect on the date of application. This application for an onsite sewage system DOES
NOT assure you of any o er County approvals. For example, it DOES NOT GUARANTEE that
you will later obtain permis io to build a permanent residence or other structure on this parcel. Any
future application will be s p at i jud•-• by the rules and laws in effect at that time.
Prop rty Owner'',ignature Date
FOR OFFICE l/SE ONLY 1(17/0
•
j.�l l°1 (V/ .
l PARTIAL ASBUILT2 / FiNALgn I
APPROVED r
INSP/PUMP TEST 5122/b PUD 0 (21-I I
ALL HOLL8EQ.MET lCY •k co(.0)1A ok.
Date/1,179-40 Feel. Rec 1/1- 115 Check# b t r Case#SEI C.f)r
GA7ata1WpwlCounty&State FormaWefferson1Septic Permit Former.owdery 701224005&021.wpd .
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