HomeMy WebLinkAboutSEP2021-00121 - 01 APPLICATIONJefferson County Environmental public Health
6'15 Sheridan St., Port Townsend WA 98368, (360) 335_9444
SEPTIC SYSTEM PERMIT APPLTCATION
PROPERTY OWNER
MAILING ADDRESS
PHONE
SYSTEM DESIGNER
()EMAIL
Designer Phone# 36o -18<-36az-
LEGALDEScRIpfloN: section Z tovnsnip2?y' Ranges/-,L)pARcEL#o06
Subdivision Name sion-Btock-Lotg) 6 ?
Site address & Directions to ite & test pits
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DISCLAIMER-This application is for an on-site sewage system that meets the state and countystandards in effect on the date of application This application for an onsite sewage system DOESNOT assure you of any other Cou nty approvals. For example,it DOES NOT GUARANTEE thatyou will later obtain permission to b uild a permanent residence or other structure on this parcel, Any
at that time.
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future n will be judged by the rules and laws in effect
U/
re Date
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A
SOURCE OF SEWAGE/USE
Residential 'O
Commercial _
Community _
System Type
Conventional lo _
Alternative
TYPE OF WORKNew-24- Tanks onty_Modifbation Exoansion
Repair- tr-t- Or"*
Replacement Tank(s)_Drainfield_
Designate Reserve AreaRedesign_
SITESIZE t,L? /rr9sqft
-
Previous Evaluation
Yes case #_ No--
Soil type-f-(anach soit evat.) Application Rate__. 6__gat./sq.ft ./day
Trench Width 3 ft. Trench/Bed Depth L,{ -jo tn.
Pump Chamber size -= gal.
TYPE OF SYS
L[L
case# see zozl-0olzl
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Agreement
a #0 #
FOR OFFICE USE ONLY
ASBUILTPARTIAL
INSP/PUMPTEST
ALL HOLD REQ. MET
-i : B -. ONS.l Tl: \Fonrns \Application Fornr & Info\SEp_permit Application Lt/26/1,8 SAR
SYSTEM DETAILS
Number of Gallons/da y 36 O*
Drainfield Length LOo 1.
SepticTanksize /Oee gd.