HomeMy WebLinkAboutSEP1970-00123IR3
503 East Caroline OLY11PIC HEA11JM1 T DISTRICT Permit No, cgle_l'I�
Port Angeles Fee Paid $ A—e
SEWAGE DISPOSAL PES M.12 APPLICATION
Submit in D upla;cate -7
tIAML7d,/" ADDRESS DATE
LEGAL DESCRIPTION PHONE
DIRECTIONS FOR LOCATING SITE !�
APPLICATION IS HEREBY MADE TO. INSTALL NEW SYSTEM REPAIR EXISTING SYSTEM
L
Property
lines
7„
E 0 ILDING
BU
`THE.
NO* OF BEDROOMS
BASEMENT SITE SIS
NAME OF INSTALLER
ON REVERSE SIDE.
DRAW A T)F.TaTT.rT)
DT.nm DT -AAT r_TITTV0 MUP
'MnT:T.nt.)TN(_ T11T_WnPM. Ar 1 n,
1#
Property
lines
7„
Driveways, patios, carports etc.
2i
Location
of building
8.
Streams or bodies of water nearby
3.
4*
Location
Location
of septic tank
9.
Location of percolation est holes
5.
Slope
of drainfield
10.
Septic tank size ?gallous
P
6„
of land
Water lines &
11.
Length of proposed drainfield
well(if applicable)
12.
Depth to water if encountered.
PERCOLATION TEST RESULTS
Depth Time required to Percolation rate Type of so 1
of hole seep last 6 in. (divide time by 6)
Perc No, 3.
Pere • No, 2 �.... �..
Perc. No. 3. .�....._.,..
DRAINFIE
LD LENGTH
WIDTH DEPTH DEPTH NO* OF LINES
IT IS HEREBY AGREED THAT THE PROPOSED INS 7TFFt
TA AT N WIL E MADE IN TH Nt
AS DESIGNED AND APPROVED ON THIS APPLICATIO
ig ature of Applicant
APPROX. DATE OF INSTALLATION
SANITARIAN 'S COMMENTS.]
s
THIS CONSTITUTES PE IT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED
PLAN APPROVED _ 0
DISAPPROVED DATE d —
DATE INSPECTED
REMARKS
5-68
>� 3
SANITARIAN
-1D
SKETCH PLAN ON GRID BELOW
SCALE --14 FEET BETWEE14 LINES
INDICATE NORTH
Map Output f �^ c 0 Wage 1 of 1
http://gisserver/servlet/com. esri. esrimap.Esrimap?S erviceName=... 6/19/2012