HomeMy WebLinkAboutSEP2021-00055 - 01 APPLICATIONI , Jefferson County Environmental Public Health
6,l5 Sheridan St., Port Townsend WA 9S368, (360) 385-944'l
SEPTIG SYSTEM PERMIT APPLICATION
STO LLC
842 Washington Street, Port Townsend, WA 98368-5774
PROPERWOWNER
MAILINGADDRESS
PHONE
SYSTEM DESIGNER
't-413',1 EMAIL ash more.jeff@ g ma il. com
Mark Stone Designer Phone 360-228-5788
LEGALDESGRIPTION: Section-2 Township-29N Range-lL PARCEL I 971900010
SuMivision Name The Meadows No. 1 & No.2 10
Site address & Directions to site & test 116 Sunset Meadows Lane, Port Hadlock, WA 98339
Cross Street is Christney, Gate Code#1234, Construction entrance open 8am to 3pm M thru F
SOURCE OF SEWAGE/USE
Residential X
Commercial _
Community _
ryPE OF WORKNew- Tanks only-f,-
Modification_ Expansion_
Repair_ Tank(s)_ Drainfield
Replacement Tank(s)_Drainfield_
Designate ReserveArea_
Redesign_
Water Source
Private_
Public X N"r" PUD #1-
stTE slzE 0.14 acre JHnx
Previous Evaluation
Yes cce*l9G3ll8_ No_
System Type
Conventional
Alternative -[
SYSTEM DETAILS
NumberofGallonsldayfu1Q-1,gSoiltype-(attachsoileval.)ApplicationRate-gal./sq.ft./day
Drainfield Length ft. Trench Width ft. Trench/Bed Depth_in.
Septic fsnk si2s '1,000 nal Pump Chambersize_gal.
TYPE OF connection to commun sEP96-338
By signing the application form, the applicanUowner 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 applicanUowner 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 attomey'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. lnspections shall occur
during regular business hours. lnitial 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-Th|s appli€tion 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 Gounty 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 application will be separately judged by the rules and laws in effect at that time.
'1 - 5'z(
Date
M
#u/1655-case # sep Z(t l' itn55
AgreementINSP/PUMPTEST
PARTIAL
ALL HO MET
FOR OFFICE USE ONLY
ASBUILT
G:B-ONSITE\Forms\Application Form & Info\SEP_Permit Application 7L/26/78 SAR
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