HomeMy WebLinkAboutSEP2000-00075 Jefferson County Permit Center
621 Sheridan St., Port Townsend WA 98368
360-379-4450 ...
SEPTIC PERMIT APPLICATION f
PROPERTY OWNER �.Wil,ez s Au?, /N) I 6cLt
MAILING ADDRESS 0,2/0 35 ,'UG giv S j
52 = F5(//c;7
PHONE Area Code ( ) j.;c? -/O5.2.
SYSTEM DESIGNER S'pnl jS Sfc
LEGAL DESCRIPTION: Section r 7 Township02 Range J PARCEL # l-o27/-6/41
Subdivision Name S 09/27-4),P/l/7.er SP Division Block Lot(s) / .Z
SITE LOCATION Fj_'; „ 0,-A '
Zip Code 9F36,6'
TYPE OF IMPROVEMENT: Residential / Residential ADU Commercial Community
TYPE OF WORK:
New X Redesign Upgrade Repair Partial (tank) (drainfield) '
Expansion Designate Reserve Area
Conventional X Alternative Drainfield Length /SD ft.
Number of Bedrooms 3 Trench Width 5 ft.
Basement: yes / m Trench/Bed Depth /o2-/R' in.
Site Size /rO O E- Number of Lines 3
Previous evaluation: yes / Tank size /OD p gal.
Water Source: private public Soil type _1 (ATTACH SOIL EVAL.)
Application Rate $ gal./sq.ft./day
TYPE OF SYSTEM /7_0,tju ,t)z ,l,9<
** .***..******* ..***.** ..******.***.***.*******... ********.****.**************************
THE UNDERSIGNED ACKNOWLEDGES THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND THAT FALSE
INFORMATION WILL NEGATE AND INVALIDATE THE APPLICATION AND/OR THE SUBSEQUENT PERMIT. THE
PROPERTY OWNER WILL BE RESPONSIBLE FOR THE ACCURATE LOCATION OF ALL PROPERTY LINES.
Signature /t/j �' Date 1//9/6)0
FOR OFFICE USE ONL V
QU-O® PARTIAL
APPROVED RENEWED PRESS/TEST _
P INAL
ASBUILT 611121,0411111 BUILT 611121,0411111 ` ‘7-2 ft/6
U D
RENEWED f�
Fire District Planning District School District Zone
Date 9-4/-00 Fe ' Oo Rec #r ?c7T/ ` Check tk, 3 Case # SEP
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