HomeMy WebLinkAboutSEP1974-00205903 E. Cara] ane OLYMPIC, HEALTH DISTRICT Permit No. 4;0
Port Angeles SEWAGE tispcsA.�AMIT APPLICATION
Submit in Duplicate Builaex�.�
Court House
Port Townsend WA4ivc -Aa�a_l` Date q 1.2-7! 71
f, 77
OWNER DRESS PHONE 3
DIRECTIONS FOR LOCATING S
APPLICATION- IZ--HMEBIt MADE'TO: IXSTALL Nr§4__8f5tM_-KREPAIR EXISTING SiSifik
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DRAINFIELD LENGTH\AQ, jrIDTH DEPTH 1 #LTNES SEPTIC TANK S27
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DRAW A `BELOW. SEE INSTRUCTIONS. SOIL TYPE
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Affy-C-H-A01 I BUI - NG OR SL" --A DISPOSAL PLANS, -MCATION ORct-SI%_TE 9 INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
DATE OF INSTALLATION SIGNATURE OF APPL3:CANTK,*c'p.(
Sh�OV DATE INSPECTED.B QZ��, 'gApr.
��CANITARIANVS C011MENTS:
-CERTIFY THAT THIS '.-!AS'If\TSTALLED IN THE MANNER APPROVED BY THE
,I YI
HEALTH DEAPRTFln_,T DATE
INS ALLERS NAME
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t)tAlw fRO?w INTI RSjC7ION OF ROcO A'• C1&�
O pevIl1 P 1
_perhe /Q Iron or r•nOm�r•
LEGAL DESCRIPTION- SWd...n.on
Lot
W 13 301 1��I % Se[tr0^ S<[r.On 70wn•n.p ^�^ir
Tax humOfr
11. )Yrt ANL) I.U-,oa ur outt_uti�v
TYPE OF IMPROVEMENT
8UILDING TYPE MOBILITY
❑S.ngir Family LJ New County Resident
Nfw building
/0 Addrt,on
G Alteration
❑ Repair repiacrment
❑ Mu1n-Family is tors strict care to carve. me rnwe^tial
number Of units o. corrnmerc.al needs of thine emp.oved
❑ Hotel. Motel. Gorr 10ty at e.I her the US r Na.ry t Tr.ornI or
number of unrrt Inc... Island Fac.l.nes�
❑ Ilbeckrnp
(3Mo..rng (retoca=.on)
❑ Mobile Home
ther - Specify G YES ONO '.
AD,
p Foundation only
'
USE
OV:NERSHIP
❑ Private (individual, coroorar+on•, _
, ;j�-v,� ❑ Fu11-11me Res.den=
0 Second H'onne. Rec*eauon Cabin• etc_
nonprofit inslitutton• etc.)
❑Public (Federal_ State or loot 90'/t-)
Second Hoe. Future con-s.on to
�jrn..-
USC OCCUPANCY GROUP: pe,r^ tient res,del=
COST
• (qu of impro.e Ment_ _ _ _ _ _ .. . - - - S
To be ins:a/%ed but not included
rn me abo..e carttore,
It. PlunL.ng------------•--•-
al - peso.be in detail proposed use of budd.^gs. e 9 . food
/Omit cent, E
nt• machine shoo, laundry buwid•nc at hosp•tai. ele-en:ary
danaepenial sc'+ooi, oar<.^g ��ax For
rental office buadrng. office bu•id•ng at rriouste-a oiant
ting bu.id•ng is being cna^ped- a^ie• o•oxsed use
CXR X 1/)-I V /� tv17 119t
c- Heating. air conditioning - - , _ _
d Orner (elevator- etc.) -----------
--.------TOTAL
TOTAL COST OF i.-APROVEMENT S
QS •_���
III. SELECTED CHARACTERISTICS OF BUILDING -
I
DIMENSIONS
_ _ _ _ _ _ _ _ _
� Numoer of Stories _ _ _ ..........
I
PRINCIPAL TYPE OF FRAME
TYPE OF SEWAGE DISPOSA
❑ Masonry l•wail bearing)
❑ Wood Frame
[:]Public or Pri
.v.d,tat tsep[tc tank• etc,)
+ Total sOuare feet of floor area•
all floors, based on exterior
drmens.ons-------------------
Q Structural steel
TYPE OF WATE R SUPPL
+Total land area• sq- ft• _ - _ _ _ _ _ _ - -
❑ Reinforced concrete
❑Ocher - Scec,ty
❑ PubLc o1 ate cpmoany
,sndual (well, cistern)
NUMBER OF OFF-STREET
PARKING SPACES
Enclosed ----------------------
PRINCIPAL TYPE OF HEATING FUEL
TYPE OF FIREPLACE
Outdoors ---------------------
a Gas
Oil
RESIDENTIAL BUILDINGS ONLY
Nurrtper olbed•ooms__.._ -_ ,_
TYPE OF MECHANICAL
G E•ectrictty
Full .......
Nurrver of
s
p her - Specify
bathroo Pantal. _....
IV_ IDENTIFICATION -
Name
Nuer, street, city aril5STale ZIP cod e Tel Na_
�Addve-%s rrsb
—OR'20
t. r
o�
I
2. tate License No.
contraclo
Ar[tisect
The owner of this building and the undersigned agree to conform to all applacable laws.
apW.ont
Address ADW.cJr.on d to
®8 t�f 8!0
PLANNING AREA " FIRE DISTRICT SCHOOLDIISTRICT WATER DISTRICT
APPROVED BY C-V%�
Je AewsO•• Ola.t �7 $1� `� � � �w��.
APPROVED BY: PERMIT FEE ISSUE DATE PERMIT UM[#Ejl1
'
8f.OO
9LIIl, DING OF FICIAL
TO tit) vat
o K t�� • , �'Gc� --
Screen: 01
Parcel # 000001343019 Geo Cd 300134304210
S34 T30 R1W
TAX 10 (ENLG BY TAX 22)
* Taxpayer Cd WAGA 2740 WAGAR, HELEN
• Title Owner
Tax Code 0211 Status TX TAXABLE
Affidavit 58963 Vol/Page /
Mode: INQUIRY
Auto Roll: OFF
Nbad Cd 4110
Loc ID
TIP Chg Dt 9/23/2005
T/P Chg Usr JA
Land Use 1100 RES -SINGLE
C/U Code