HomeMy WebLinkAboutSEP1985-00191 NI,vNwk"DEL fr, /N , . .
._ Prr.RMtT MIL EXPIRE ONE YEAR FROM DATE ISSUW.AP41.1s' '. ,.
FOR'�"WEL FOYI Oi n YEAR`ti THIN 33 DAYS BEFORE D(PIRATIO1V. •
JEFFERSON COUNTY HEALTH DEPARTMENT _ E O 5 - tek
802 SHERIDAN AVENUE ���
INSTALLER __ PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO.
(206) 385-0722 -
BUILDER , rti-. III DATE 7-/-2-?�
. SEWAGE DISPOSAL PERMIT
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Owner Address Phone d r
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Directions for locating site N O
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INSTALL NEW SYSTEM C REPLACE SYSTEM❑ PARTIAL REPAIR❑ TANK/DRAINFIELD Q 0
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, ti TYPE OF NO. OF • c SITE c t7
F.,- BASEMENT O -SIZE / ?3AC. H
BUILDING /�( 2w� � BEDROOMS ' � �
Previous site evaluation by SOIL TYPE DESCRIPTION I I" i x O
Health Department I � ),,�
Yes No 1) C� r A���J
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Depth to maximum seasonal .fie G - I,-`^^.1-- r� w
water table _ /�
Source of potable water supply 2) (7 - 3S � ),
Public ) Private 35'y 7 f J� h -♦
,,, rk Source type: Drilled well 1t7-lntQ �Sd.
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Other 3) b- `°,.� '-� J 0 _
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EVERY vAPPLICANT HAS THE RIGHT OF j Co to - hLI C " S Z
APPEAL AS PER JEFFERSON COUNTY ' Csc,.—
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ORDINANCE -77. '/7 411111k.:':c i z• ..k. L______—.
S G ATURE OF APPLICANT Z
ANY REMOVAL OF OR MAJOR DISTURBANCE I OF SOIL IN THE PROPOSED OR APPROVE) DRAINFIELD NF 1 ELD CO O
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AREA MAY CREATE SITE CONDITIONS THAT OR EWAOGRE DISPOSAL PLANS IINCLIIDING 8 -y
• SEWAGE DISPOSAL SYSTEM. ;`
PLLF'BING STUBOUT LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES a
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PERMIT UNLESS PRIOR APPROVAL IS OBTAINED FROM THE HEALTH DEPARTMENT.
for final inspection). STUB OUT PLUMBING ABOVE FOUND* 49, FOOTING. O
Drainfield Length �I0 a Trench width .2 t Trench depth I,o.lines 3 Tank size /06(f) >
Soil type and application rate used for esign a GPD/ft2. — II . a O rn
COMMENTS: � e�g� @'�` CC - ? .
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DATE INSPECTED PART ti,. DATE p m
APPR�` ED 1
I certify .pat this system =in. :1 ed in a manner approved by the Health Department d 1 m_ =,__
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INSTALLER'S SIGNATURE DATE
DATE INSTALLED m
JCHDJ7-84 actytb, - 0,086' ," Y` /
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