HomeMy WebLinkAboutSEP1973-00173Caroline OLYMPIC HEALTH DISTRICT Permit No.__�
Angeles SEWAGE DISPCSAL PERMIT APPLICATION
Submit in Duplicate Builder
�t .House
c Townsend q%, � � �.0-13 Date � 'o
I R,�� : �,� r _._._ADDRESS P�IONE�
$MCTIONS FOR LOCATING `S
4 � i v
APPLICATION IS HEREBY MADE TO: INSTALL Nom? SYSTEM REPAIR EXISTING SYSTEM
I
�
YPE OF B ILDING
N0. OF BIDRfMS
BA�SENtENT
SITE IZA
NAME OF INSTALLER
DRAINFIELD LENGTH IJIDTH DEPTH #LINES SEPTIC TANK SIZE
DRAW! A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE
/9- 3173 _ CA-a-S-e&Lr�
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ANY CHANGE IN BUILDING OR SLI -AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES IS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT,
DATE OF INSTALLATION SIGNATURE OF APPLICANJ(jQ-
APPRWED DA'L'E _INSPECTED BY DA w�
SANITARIAN'S COMMJWTS:
I CERTIFY THAT THIS SYSTEM BIAS DISTALLED IN THE MANNER APPROVED BY THE
HEALTH DEAPRTMENT DATE
INSTALLERS NAME
903 E: Caroline OLYMPIC HEALTH DISTRICT
Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION
Submit in.Duplicate
Court House
Port Townsend
OmER,�A' ADDRESS
4....
DIRECTIONS FOR LOCATING SITE Z 7= ao .�
Permit No.
Builder
Date.
APPLICATION IS HEREBY MADE TO: INSTALL N'311 SYSTEM REPAIR EXISTING SYSTEM
YPE OF BUILDING4 NOOF BEDRdOM BASEMENT I SITE SIZA NAME OF INSTALLER
DRAINFIELD.LENGTH',TIDTH DEPTH #LINES SEPTIC TANK SIZE
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE
4e
ANY CHANGE IN BUILDING OR SEAGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES IS
PERMIT UNLESS PRIOR APPROVAL 033TAINED FROM THE HEALTH DEPARTMENT.
DATE OF INSTALLATION _ SIGNATURE OF APPLICANrf
APPROVED DATE INSPECTED BY DATE_`
SANITARIAN'S COMMENTS:
I CERTIFY THAT THIS SYSTEM ':IAS DTSTALLED IN THE MANNER APPROVED BY THE
HEALTH DEAPRTMENT DATE
INSTALLERS NAME
Parcel Number: 981301412 rngFriendlx
Owner Mailing Address:
OTTO FISCHER
1913 CHAMBERS ST SE
OLYMPIA WA985013115
Site Address:
Section: 21
Qtr Section: NEI/4
Township: 25N
Range: 2W
School District: Brinnon (46)
Fre Dist: Brinnon (4)
Tax Status: Taxable
Tax Code: 441
Planning area: Brinnon (11)
Sub Division: OLYMPIC CANAL ADDITION 5
Assessor's Land Use Code: 9800 - GARAGES, SHEDS (out -buildings only)
Property Description:
OLYMPIC CANAL ADDITION 5 1 BLK 14 LOT 12 1 1 1
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