HomeMy WebLinkAboutSEP1973-00007L -P -T r H e
Po 00,k-73
903-E- Carolin OH DISTRICT SEP7Permit No*3,?-3
Port Angeles SWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
ourt House
Port Townsend Dat
01=R ` ADDRESS QA c, PHONE
DIRECTIONS FOR LOCATING SITE "Al
-30
APPLICATION IS HEREBY MADE TO: INSTALL NaT SYSTEM `REPAIR EXISTING SYSTEM 11�
DRAINFIELD LENGTH 1.1IDTH DEPTH #LINES SEPTIC TANK SIZE
ANY CHANGE IN BUILD NG OR SL -AGE DISPOSAL PIANS, LOCATION -OR,SITE9 INVALIDATES THIS
PERMIT UNLM-S PRIOR APPROVAL OBTAINED FROM THE.HEAITH DEPARTMUTTO,
DATE OF INSTALLATION SIGN)WURF, OF APPLICANT
APPROVED DATE 3 h(a INSPECTED By %,ATE2L�,
SANITARIAN'S C014MENTS:
I CERTIFY THAT EM ':SAS THIS ISTAL INT MANNER APPROVED BY THE
HEALTH DEAPRTMI;NT _XM
DATE
I
0 yon®
I
S
YP OF BUILDING NO. OF BIMROOMS
BASEMENT
SITESIZ
NAME OF IkST
DRAINFIELD LENGTH 1.1IDTH DEPTH #LINES SEPTIC TANK SIZE
ANY CHANGE IN BUILD NG OR SL -AGE DISPOSAL PIANS, LOCATION -OR,SITE9 INVALIDATES THIS
PERMIT UNLM-S PRIOR APPROVAL OBTAINED FROM THE.HEAITH DEPARTMUTTO,
DATE OF INSTALLATION SIGN)WURF, OF APPLICANT
APPROVED DATE 3 h(a INSPECTED By %,ATE2L�,
SANITARIAN'S C014MENTS:
I CERTIFY THAT EM ':SAS THIS ISTAL INT MANNER APPROVED BY THE
HEALTH DEAPRTMI;NT _XM
DATE
`RECEIV�'
AUG 2.6'80
ON-SITE SEWAGE DISPOSAL SURVEY OF
JEFF. COUNTY,
HEALTH DEPT.
I. Location, Lot Size
Street Or
Division Block Lot Landmark Lot Size
Ian I vnppLr
II. System Owner
Address_
Telephone Number
Permit (?) (Previous Owner)
Date Issued I q`Z
I I I. X Instal l er �A?
p \ \Qa Date -Installed
ime In -Service (years) 13
XSeptic Tank Pumped X
- YES NO HOW
OFTEN
A # of Months/Years Residence Occupied?
13Ry s
X Average Number of People Served
x Number of Bedrooms
X Clothes Washer
YES
NO
k Dishwasher ----
YES
NO
xGarbage Disposal
YES
NO
IV.. Type of cover over drainfie.ld. (i.e. grass, landscaping, etc.)
V. Repairs (when, what, who) Cause of Failure
,y009
VI. Comments (Over for Sketch)
VII. Action Taken
SEWAGE DISPOSAL PERMIT APPLICATION
JEFFERSON COUNTY PERMIT CENTER
621 SHERIDAN STREET, PORT TOWNSEND, WA 98368 (360) 379-4450
DATE RECEIVED/REVISED:04/17/98
PERMIT NUMBER:SEP73-0007
Application to CONSTRUCT, ALTER, REPAIR OR MODIFY A SEWAGE DISPOSAL SYSTEM
IN JEFFERSON COUNTY, WASHINGTON
-------------------------------------------------------------------------
OWNER PHONE:
ISSUED TO........: JOHN CHERRETT
MAILING ADDRESS..:
PO BOX 78
GARDINER OR 97441
INT PHONE:
INTERESTED PARTY.:
MAILING ADDRESS..:
DESIGNER.........:
MAILING ADDRESS..:
PARCEL NUMBER....: 940800020 STR: 13-30-02W
(Permit valid for this/these parcel(s) ONLY)
LEGAL DESCRIPTION/SUBDIVISION: CAPE GEORGE VIL4 BLOCK:
LOT(S):20
LOCATION.........: 30 MAPLE DR
--------------------------------------------
TYPE OF SYSTEM: CONVENTIONAL
TYPE OF WORK • EES
ASSIGNED TO: RANDY
FEE: _EES $ 89.00 MM 04/17/98 1210
STORMWATER YES NO
wetland erosion seismic streams
flooding _ landslide _ f & w _ plat cond _
(sep _app.txt) 07/10/93
I
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