HomeMy WebLinkAboutSEP1971-00076IULIWIC= HEAL'M PTSTRICT Persni.t No.`_
. -Angeles Fee . Paid $
SEWAGE DISPOSAL PERMIT APPLICATION
Submit ir. Duplicate
!i..�,...�..Qw...�....ADDRESS,
5,, - 14219 P F FL',1:511Y3.,.r.. DATE . _?
Spokane, WA 99203
LEGAL DESCRIPTION-Tax.438... Sen. 33, T -An P 'F, WM..:....-�.._r.�.�.� PHONE RT Z_�Za
DIRECTIONS -FOR LOCATING SITE
APPLICATION IS HEREBY MADE TO s - INST&Lt NEW SYSTEM x _EFAIR EXISTING SYSTEM
tResidence
2 No 100 x 400 �����
-,YPE OF BUILDING b0, OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLFRJ
ON THE RE
SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING TNFORMA'1'IO1
1/.
lo_Property-
lines 7. Driveways, patios, carport, etc.
2. Location
of building 8. Streams or bodies of water nearby
3• -Location
4.--T,ocation
of septic tank 9. Location of percolation test holes
of drainfield 10. Septic tank sa.�e�Q„dam, Sams
5-- S1oPe of
land il, Length of proposed drain f field
"ater lines & well(if applicable) 12. Depth to water if encountered.
.. _.,_PERCOL ITION. TEST- RESULTS
Depth Time required to Percolation rate Ype of 0011
4
Pere. No. 1'
of hole seep last 6 in. (divide time by Q
�
Pores_ No. 2
_
4IPJFI�ELD LENGT WIDTHDEPT$ ®Z ��! NO. OF LIPtES
IT -.LS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN 'IHE� PONIZEL.Y
A,.3 --DESIGNED AND APPROVED ON THIS APPLICATION.
o. o
-APPROX, DATE OF INSTALLATIONSignature of App c nt_ ��
SAPIITARIAN 13 COMMENTS:
' Z_i:.ONSTiTUTF�S A PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS Ar'rRO�`�':��s
PLAN _APPROVED
DATE �b3h (
REMARKS:
5-68
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`' 903 East Caroline OLYMPIC HEy7,!'_'?T T'TSTRICT Court House
Port Angeles Port Townsend
BUIT. ING SIaF APPLICATION
OWNER `Jll e ISc� A) LI 1 w... ADDIRLLS 2 )4d jepeeaon,DATE�lZ
LEGAL DESCRIPTION 1ec, i 0 0.1 •C W M
D.Lr'LEXTIONS FOR LOCATING SITE�►'�iga. ,eus�a�•� -I-e 1Q�. �� h®� �- uST
fav F4Si- h 1-daA be_ `
AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR Z
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
KA,SIDENCE__.,X_ .,` COMMERCIAL BUILDING OTHER
N0. BEDROOMS BASEMENT SITE SIDE SOURCE OF WATER tP
TYPE OF SOIL DEPTH TO WATER TABLE }
?�R.A.W A SKETCH i� .be-space-beZs�w�- i d3eating Too tion of building in re14 `.i,. 4
�.I- . _ _._.�
to other- b %ldings, property lines, well, streams or other,bodies of water -r.
Indicate p;;posed location of sewage disposal system. `
Date of Site Inspection pP
Approved"!_ Disapproved
� r - r�
See reverse side for remarks.
THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE P221NIT TS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.
Parcel # 000021332022 Geo Cd 302133203210
533 T30 R1E
TAX #38
* Taxpayer Cd HIGH 3410 HIGHFIELD TRTEE, WILSON 0
* Title Owner
Tax Code 0211 Status TX TAXABLE Land Use
Affidavit' 65858 Vol/Page / C/U Code
Leqal Doc QCD 7/13/92 Amount
Taxpayer
HIGH3410
Search Ke
WILSON 0 HIGHFIELD TRTEE
BONNIE DEE HIGHFIELD TRTE
HIGHFIELD REV TRUST
2670 E MARROWSTONE RD
NORDLAND WA 98358-9519
Mode' INQUIRI
Nbad Cd 3160
T/P
Chg
Dt
7/31/1992
TIP
Chg
Usr
PM
1100 RES -SINGLE
S/C Cd
0TH