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HomeMy WebLinkAboutSEP1971-00037. .. I po DISAPPROVED REMARKS: I)k'L Gaw►'� I CERTIFY THAT THIS SYSTEM WAS INSTALLED IN THE MANNER APPROVED BY THE REALT$ O6 DEPARTMENT. 5--68 INSTALLERtS NAME DATE Time required to Percolation race Of hole 61 hype vi OVA". SEPTI I - 0OB7 seep �:ast 6 in. (divide time by Fit Caroline OLYMPIC HEALTH DISTRICT. 'Permit No. :t..AnVles Fee Paid $ SEWAGE DISPOSAL PERMIT APPLICATION - Submit in Duplicate 12RAINFIELD LENGTH a .WIDTH la DEPTH �-<Zf NO. OF LINES ATE' n I`ME HEREBY fia-DESIGNED AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MAININER AND ADDRESS APPROVED ON THIS AIPPLICATTON. IX4AL. PHONE, N DIRECTIONS -FOR LOCATING SITE •APPROX- _DATE f Signature of OF INSTALLATION � /& hi _ Te, rk ✓• V . j1 APPLICATION IS HEREBY MADE TO: INSTAL NEW SYSTEM7, %REPAIR EXISTING SYSTEM [qUILDING r Z N0. OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLER V'ERSB SIDE, DRAM A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMA`1I0 1. Property 1.iaues 7. Driveways, patios carports etc. 2. Location of buildiaa,g 8. Streams or bodies of water nearby+, 3 ---Location of septic tank 9. Location of percolation test holes, •.._.Location of drainfield 10 Septic tank size ga110-" 5. ---.Slope of land 6—Mater lines 11. Length of proposed drainfield & well(if applicable) 12. Depth to water if encountered. PERCOLATION TEST RESULTS .•.1L _r 39 . .. I po DISAPPROVED REMARKS: I)k'L Gaw►'� I CERTIFY THAT THIS SYSTEM WAS INSTALLED IN THE MANNER APPROVED BY THE REALT$ O6 DEPARTMENT. 5--68 INSTALLERtS NAME DATE Time required to Percolation race Of hole 61 hype vi OVA". Perc. No. 3. seep �:ast 6 in. (divide time by Pere. No. 3. - 12RAINFIELD LENGTH a .WIDTH la DEPTH �-<Zf NO. OF LINES n I`ME HEREBY fia-DESIGNED AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MAININER AND APPROVED ON THIS AIPPLICATTON. N H •APPROX- _DATE f Signature of OF INSTALLATION � /& hi _ Te, rk 75Plicant j1 SANITARIAN ' S COMMENTS: r Z R . .. I po DISAPPROVED REMARKS: I)k'L Gaw►'� I CERTIFY THAT THIS SYSTEM WAS INSTALLED IN THE MANNER APPROVED BY THE REALT$ O6 DEPARTMENT. 5--68 INSTALLERtS NAME DATE r SKETCH PLAN ON GRID BELOW SCALE-10-PEET BETWEEN LINES INDICATE NORTH ;11 t 1 rf' I s 9 f i East Caroline OLYMPIC HEALTH DISTRICT 'Permit No. !?- . -Angelus Fee Paid I SEWAGE DISPOSAL PLRMIT APPLICATION Submit in Duplicate ADDRESS ATE..�G��Ld��...� IXGAL DESCRIPTION PHONE DIRECTIONS -FOR LOCATING SITE Ne K P _C140 APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM r�REFAIR EXISTING SYSTEM ,moo --slow . V��yb�1.fSaa. -- E OF BUILDING N0. OF BEDROOMS BASEMENT SITE SIZE I NAME OF INSTALLER ----j n u� �n.�. is r uv -x ri-tK v %71 V 111\7 J.u.j .L VLYV YY -- -......__------ 1. Property lines 7. Driveways' patiost carports etc. 2. Location of building 8a Streams or bodies of water nearby 3-•._Locatioa of septic tank 9. Location of percolation test holes ; 4. -Location of drainfield 10. Septic tank size 5'-Zl°pe of land 11. Length of proposed drainfield � 6„--WaF tsr lines & well(if applicable) 12. Depth to water if encountered. PERCOLATION TEST RESULTS Pere. No. of hole s ], P8rc.. No. 2 Pero. No. 3. DRAINFIELD LENGTH ,g me required to TPercolation rate ep last 6 in. I (divide time by 6) WIDTH /n r „a -DESIGNED AND APPROVED ON THISrAPPLICATION. 2-Ir7 r i.. �,atur�f Applicant APPR4�C. DATE OF INSTALLATION (%y S.ANITARIAN' S COMMENTS: REMARKS: Cov,*,r DISAPPROVED lib Ab Arrxuv.• DATE__ 5A7-17-1 f r r 0 I CERTIFY THAT THIS SYSTEM WAS INSTALLED IN THE MANNER APPROVED BY THE HEALTH ,� DEPARTMENT. 5"68 INSTALLERIS NAME DATE 903 East Caroline OLYMPIC HEALTH DISTRICT Court House Port Angeles Port Townsend BUILDING SITE INSPECTION APPLICATION Submit in DuDl,-? cLte OWNERS�� f' n,2._�—ADDRESS e \k DATES ZZ/ LEGAL DESCRIPTION DIRECTIONS FOR LOCATING SITE AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM. RESIDENCE 'COMMERCIAL BUILDING OTHER NO. BEDROOMSE­BASEMENT — SITE SIZE SOURCE OF WATER TYPE OF SOIL s9�� DEPTH TO WATER TABLE 'RD AWA SKETCH in the space below, indicating location of building in rel&tl on to other buildings, property lines, well, streams or other bodies of water. Indicate proposed location of sewage disposal system. 4AA'- Q -1 - Date of Site Inspection_ 56? -7 h/ C' �S SIGNATURE Approved'"/ Disapproved * * See reverse side for remarks. Sanitarian THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PEPiJIT IS NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.