HomeMy WebLinkAboutSEP1970-00027903 East Caroline
Fort Angeles
SEP70- boa'7
OLYMPIC HEALTH DISTRICT Permit No.
Fee Paid $
SEWAGE DISPOSAL PLIP111T APPLICATION
Submit in Duplicaatte
NAME. Harold T. Dodge ADDlRrESS 16 4 , 14�ptb N.WW,, the DATE 6-12-70 _
LEGAL DESCRIPTION Lot 4, Sguamish Harbor Beach -Hood Canal � PHONE; L1:2
DIRECTIONS FOR LOCATING SITE tiff South Point Road -there is a road into building site
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM x REPAIR EXISTING SYSTEM
Saa- S loo LV
Residence 3 No 60 x 300
J OFTBUILDING NO, OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLER
LoPt'u Time required t
of hole seep last .6 in.
Pere. No. 1
Pere. No. 2
Perc. No. 3.
rercolatlon rate
(divide time by 6)
t
DRAINFIELD LENGTH.�
WIDTH DEPTH . NO, OF.LINES TT IS IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
PTS DESIGNED AND APPROVED ON THIS APPLICATION,
Signature of Applicant \
APPROX. DATE OF INSTALLATION
iANITARIAN'S COMMENTS;
THIS CONSTITUTES A PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED �
PLAN APPROVED, DISAPPROVED DATE ",3D -7th
DATE INSPECTED G%_ cf SANITARIAN a
REMARKS:
5-68
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PLAN UIVING THE FULl,UWjflU 1Vj-Ux1V1A 1U
1.
2.
Property
Location
lines
7.
Driveways, patios, carport, etc.
3.
Location
of building
of septic tank
8.
Streams or bodies of water nearby
4.
Location
of drainfield
9.
10.
Location of percolation test holes
Septic tank size /,off $allc�n0
.
.
Slope of land
Water lines & well(if
11.
Length of proposed drainfield
applicable)
12.
Depth to water if encountered.
PERCOLATION
TEST
RESULTS
LoPt'u Time required t
of hole seep last .6 in.
Pere. No. 1
Pere. No. 2
Perc. No. 3.
rercolatlon rate
(divide time by 6)
t
DRAINFIELD LENGTH.�
WIDTH DEPTH . NO, OF.LINES TT IS IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
PTS DESIGNED AND APPROVED ON THIS APPLICATION,
Signature of Applicant \
APPROX. DATE OF INSTALLATION
iANITARIAN'S COMMENTS;
THIS CONSTITUTES A PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVED �
PLAN APPROVED, DISAPPROVED DATE ",3D -7th
DATE INSPECTED G%_ cf SANITARIAN a
REMARKS:
5-68
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'SKETCH _
P�, NII ON GRID " BELOW
SCALE--lt,FEET BETWEEN MINES
INDICATE NORTH
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903 East Caroline OLYMPIC HEALTH DISTRICT Court House
Port Angeles Port Townsend
BUILDING SITE INSPECTION APPLICATION
Submit D_u l icate,
16945 14bN.W. Seattle
OWNER *o P,A DDRESS 9$177 _+DATE .0470
LEGAL DESCRIPTION X---�r g5 �
DIRECTIONS FOR LOCATING SITE CJI J®
AN APPLICATION IS HERESY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
PXSIDENCE X .COMMERCIAL BUILDING OTHER
NO. BEDROOMS BASEMENTO,SITE SIZE&/0j(-gd0e SOURCE OF WATER 4&1
TYPE OF SOIL ,_` DEPTH TO WATER TABLE p,���® ��✓
":RAW A SKETCH in the space below,, indicating location of building in relation
to other buildings, property lines, well,,streams or other bodies of water"
Indicate proposed location ;of sewage disposal system.
4
2 3G J
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Date of Site Inspection 6"78CrN ww APPLL ANT fS SIGNATURV
Approved* Disapproved
��/
AQ
Sanitarian
See reverse side for remarks.
THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PERMIT IS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.