HomeMy WebLinkAboutSEP1973-000877�e�5.&" A AX
903 E. Caroline
Port Angeles
Court House
Port Townsend
OLYMPIC HEALTH DISTRICT Permit No,.�i
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
DIRECTIONS FOR LOCATING SITE gee
31 C:�eaMGL)n� 0(:
Date
TION IS HEREBY MADE TO: INSTALL Nal SYSTEM X REPAIR EXISTING SYSTEM
02` BROOMS BASEMENT S SITE SI Z 9 kiITALLER
OF BII I G ^ NO.
DRAINFIELD LENGTH)0 6 jJIDTH_J&XLEPTH #LINES SEPTIC TANK SIZE
DRAW A DETAILED PLOT PLAN.BELOVI. SEE INSTRUCTIONS. SOIL TYPE
ANY CHANGE IN BUILDING OR SL --AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
P""if"liT UN SSS PPIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
DATE OF.INSTALLATION SIGNATURE OF APPLICANT
APP3R ED `�®� DATE ' 2-f" INSPECTED BY DATE
SANI`l'ARIAN ' S CON 1ENTS%:
I CERTI
HEALTH
ROVED BY THE
DATE
�, ' ' �' .;
G.o -
Jefferson County Department of Community Development
621 Sheridan St., PortTownsend WA 98368 (360) 379-4450
MONITORING INSPECTION CERTIFICATION
The system serving
parcel # C)rYD rrC_ / permit #- was most
recently inspected on -3-11-02— by Vfi� _ . as specified in
Jefferson County Code 8.15.150.
The above referenced system is in compliance with the Monitoring/inspection schedule
identified in Table 1 of Jefferson County Code 8.15.
F] See report completed for information on the condition of the
onsite sewage system.
IXREQUIRED OR RECOMMENDED REPAIRS/MODIFICATIONS TO THE SYSTEM ARE
LISTED ON THE INSPECTION REPORT DATED 3-+7--d2 Failure to
complete repairs or modifications to the system as listed on the report may result in
premature failure of the system.
The next inspection required for this system is in 2D(2 5
Table 1 requires that this system receive an inspection:
Annually
Every 3 years
Every 6 years
Other as specified in the sewage disposal permit conditions -
An inspection will be required at the time of sale if the system does not comply with the schedule set
by Table 1 as described above.
The above information is based on review of the file and does not imply or grant a guarantee of
current or future system performance.
Signature of Jefferson
Employee
If: em_hcalth\linda'�GD\FORMS\MONITORING INSPECTION CERTIFICATION.doc
3 D�..
Date
"Welcome to Jefferson County, Washington
Parcel Number: 993000004
Owner Mailing Address:
MYRA VAN ORNUM
PO BOX 1415
KOLOA HI967561415
Site Address:
31 SEAMOUNT DR
BRINNON 98320
Section: 32
Qtr Section: NW1/4
Township: 25N
Range: 2W
Mapped Acreage: 0
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SdhW Disbi t: Brinnon (46)
Fire Dish Brinnon (4)
Tax Status: Taxable
Tax Code: 441
Pbruiing area: Brinnon (11)
Sub Division: SEAMOUNT ESTATES DIV 1
Assessor's Land Use Code: 1101 - MOBILE HOMES (owns mobile &
land)
Property Description:
SEAMOUNT ESTATES DIV 1 1 LOT 4 1 1 1
Notes:
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FOR INFORMATIONAL PURPOSES ONLY -
Jefferson County does not attest to the accuracy of the data contained herein and
ekes no warranty with respect to its correctness or validity. Data contained in this
map is limited by the method and accuracy of its collection.
Zoning information is based on the 1998 Comprehensive Plan Map and does not
include changes made during the 1999 Comprehensive Plan amendment process.
Zoning designations must be confirmed with the Department of Community
Development.
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