HomeMy WebLinkAboutSEP2008-00164 - 01 APPLICATION I'I
' 1111- Jefferson County Department of Community Development
621 Sheridan St., Port Townsend WA 98368, (360) 379-4450 �f?V
SEPTIC PERMIT APPLICATION
PROPERTY OWNER Kathleen Hudson JUL 3 0 2008
MAILING ADDRESS 4567 McNeill St Port Townsend 98368
PHONE (_360 )_385-3385 i
ifffEhatt 011 I.3�
SYSTEM DESIGNER Nathan Cleaver Septic Design Inc Designer Phone#_(360)598-6546 C j� U
LEGAL DESCRIPTION: Section_32_ Township_31 N_ Range 1W PARCEL#_999-006-301,999-006-203_
Subdivision Name _Tibbals Lake Park Division Block_63_ Lot(s)_1-10
Site address/Directions to site North on Jacob Miller. Right on Sutter St. Site on Right. . 3a j"�t�` irc+
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential_x_ New_x_ Tank/s only Private
Residential ADU Modification Public x
Commercial Expansion
Community Upgrade
Repair SITE SIZE_111,513_
SYSTEM TYPE Partial Repair- (tank) (drainfield) Previous Evaluation
Conventional Designate Reserve Area Yes# 07-357
Alternative x Redesign No
—
SYSTEM DETAILS
Number of Gallons/day_360 Soil type 4-5_(attach soil eval.) Application Rate .4 gal./sq.ft./day
Drainfield Length 18.5 ft. Trench Width_19_ft.ea-ch Trench/Bed Depth NA in.
Septic Tank size_1000 gal. Pump Chamber size 1000 gal.
TYPE OF SYSTEM GLENDON M-31 BIOFILTER
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. Staffs 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 other County approvals. For example, it DOES NOT GUARANTEE that
you will later obtain permission to build a permanent residence or other structure on this parcel. Any
future p 'cation will separately judged by the rules and laws in effect at that time.
L �t ) -7 /i6 /20oQ'
Property Owner Signature Date
FOR OFFICE USE ONLY
a O PARTIAL ASBUILT 12,b t FINAL _
P OVED
INSP/PUMP TEST kA � PUD
ALL HOLD REQ. MET - Q
Date '�' Fee �(2\ Rec# C7L7(q"�f j Check# Case#SEP —\(QL`
Macintosh HD:Users:kiara:customer files:Lam, Phuoc:HudsonJefferson County Permit.doc