HomeMy WebLinkAboutSEP1970-000103
`70 o®I�
9G3_Jast Caroline OLYMPIC HEALTH 1PISTRICT Permit No.
Port Angeles Fee Paid'
SEWAGE DISPOSAL PE,R111T APPLICATION
Submit in Duplicate
NAl'Sager, Clarence FADDRESS_ p_ pox p��,Rs.,,m ,DATE, Q_
Wu
LEGAL DESCRIPTION ____S. of Hadlock. SEP/z o ,tli e j i -ng, 11 of HONE ��
..
T 54
DIRECTIONS FOR LOCATING SITE On road between iiadloc.4 and [him yarnj,t Qj
Hadlock store. House is on corner where road goes to new church. 2Rmxt dom
ors
towards Chimacum from Surace Construction.
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM .f REPAIR EXISTING SYSTEM
Pere. No.
Pere. No.
Pere. No.
LeP-r'a Time required t
of hole seep last 6 in.
1.
2
3•
vercoiation rate
(divide time by 6
(
DRAINFIELD LENGTH 1001 WIDTH -Q I
DEPTH N0. OF LINES ue"e-
IT IS HERESY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MAIRZ R
AS DESIGNED AND APPROVED ON THIS APPLICATION.
iggature of Applicant
APPROX. DATE OF INSTALLATION As soon as r;ossible-when approved
SANITARI 'S Q ENTS:
—THIS CONSTITUTES A PERMIT WHEN HEALTH OFFICER18 SIGNATURE APPEARS AS APPROV='
PLAN APPROVEDDISAPPROVED DATES -2- 7
DATE INSPECTED - 70 SANIT
REMARKS:
5-68
Residence
ddi on _t)
F UILDT G
1
2 none
1J0. OF BEDROOMS BASEMENT
/5 acre + 1
ot.
SITE SIZE
d
Self
NAME OF INSTALLE3
ON
THE REVERSE SIDE, DRAW A DETAILED
PLOT
PLAN GIVING THE FOLLOWING INFORMA1i0
1.
Property lines
7.
Driveways, patios, carport, etc.
2.
Location of building
8.
Streams or bodies of water nearby
3.
4.
Location of septic tank
Location
9.
Location of percolation test holes
of drainfield
10.
Septic tank sizegallons
5.
Slope of land
11.
Length of proposed drainfield
6,
Water lines & well(if applicable)
12.
Depth to water if encountered.
PERCOLATION TEST RESULTS
Pere. No.
Pere. No.
Pere. No.
LeP-r'a Time required t
of hole seep last 6 in.
1.
2
3•
vercoiation rate
(divide time by 6
(
DRAINFIELD LENGTH 1001 WIDTH -Q I
DEPTH N0. OF LINES ue"e-
IT IS HERESY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MAIRZ R
AS DESIGNED AND APPROVED ON THIS APPLICATION.
iggature of Applicant
APPROX. DATE OF INSTALLATION As soon as r;ossible-when approved
SANITARI 'S Q ENTS:
—THIS CONSTITUTES A PERMIT WHEN HEALTH OFFICER18 SIGNATURE APPEARS AS APPROV='
PLAN APPROVEDDISAPPROVED DATES -2- 7
DATE INSPECTED - 70 SANIT
REMARKS:
5-68
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903.East Caroline
Port Angeles
OLYMPIC HEALTH DISTRICT
BUILDING SITE INSPECTION APPLICATION
Submit in Du22 coat
♦. 1
Court House
Port Townsend
I1 -3(.19,
OWNER" � � ,y ADDRESS An DATE -
LEGAL DESCRIPTION
DItRpECTIONS FOR LOCATING SITE �� r�,�yra��,,� N,,x_ A
i ►h cp_ieaj--nn-8 -- 1�!— rLaeP C1iyYP�i�_�_ G pfs -lra��nvoLS
AN APWJV ION S &fff &t'f&"A P OVAL OF THS} ABOVE LOCATION FOR A
STRUCTURE WHICH WILL BE SERVED $Y AN INDIVIDUAL SEWAGE DISPOSAL SYSTEMe
HESIDENQZ OMMERCIAL BUILDING OTHER
N0. BEDROOMS ,BASEMENT.'ja.SITE SIZE d,- SOURCE OF WATER
TYPE OF SOIL DEPTH TO WATER TABLE
DAMW A SKETCH in the space below,0 indicating location of building in relation
to other buildings, property lines, well, streams or other bodies of water.
Indicate proposed location of sewage disposal system.
Date of Site Inspection _L D1 22 i T APPLT ANTS SIGNATURE
Approved*_ A Disapproved "
0 See reverse side for remarks. Sdnitarian
TH19 IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PERMIT IS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.
• � East Caroline OLYMPIC: HEAIf H ISTRICT- Permit No. 9!6y_z,
Port'�Angeles Fee Paid
SEWAGE DISPOSAL PERMIT APPLICATION ..
M 7, S`J ,
Submit � in Du l ccate
f Q
RAM ,�.s y , � _Ahh gh4vac&= DATE M
LEGAL DESCRIPTION_ _ .o %.f bon SErt Tgj U jef PHONE `
T 5
DIRECTIONS FOR LOCATING'_SITE
ia; +ick e'Gtlro. ijouse is olo oor er where road Stges to neer church►* Usmt doors
tZMAUEaRg
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM
..Z,REFAIR EXISTING SYSTEM
g` Liesidencet'::Ace +.
w m No. OF BEDROOMS BASEMENT SIZE SIZE NAS OF INSTALLER
_— • �••••,••••• w tyL* Laata VY 11 L.G1Xi.LrJL
1. Property lines
2. Location of building
3, Location, of septic tank
4. Location of drainfield
5. Slope . of land
6. Water lines & well(if applicable)
7. Driveways, patiosl carports etc.
8. Streams or bodies of water nearby
9. Location of percolation test holes
10. Septic tank size galloon
11. Length of proposed drainfield
12. Depth to water if encountered.
PERCOLATION,TEST.RESULTS
Depth - Time required to Percolation rate Type of S;11
Pere. No. 1 of hole seep last 6 in. (divide time byQ
Pere, No.
Pere. No.
DRAINFIELD LENGTH � wWIDTH DEPTH NO. OF LINES
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MA1T1i,2R
AS DESIGNED AND APPROVED ON THIS APPLICATION.
a
APPROX.
`S ' ature of -Applicant '
DATE OF INSTALLATION S .soon as ., �igilie—i,ft.,en ap,b-4roved
SANITARIAN'S COMMENTS:
PLAN APPROVED DISAPPROVED DATE 1 �' c����
DATE INSPECTED SANITARIAN
r
REMARKS:
5-68
JEFFERSON COUNTY BUILDING APPLICATION
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
360-379-4450
PERMIT #••.•:BLD96-0707
SITE ADDRESS:321 CHIMACUM RD
:PORT HADLOCK, WA 98339
-------------------------- ----------------
APPLICANT ... :MAUREN MCKENNON
MAILING ADDR:COTTAGE COLLECTIBLES
:PO BOX 435
:PORT HADLOCK WA 98339
------------------------------------------
CONTRACTOR..:
MAILING ADDR:
CONTR. LIC #: EXPIRATION
--------------------------------------
ARCHITECT/..:
DESIGNER....:
MAILING ADDR:
r
DATE RECEIVED.:11/13/96
------------------
PHONE:
PHONE:
DATE:
----------------------------------------
PHONE:
-------------------------------------------------------------------------------
PARCEL NO.:973500102 landslide plat cond wetland flooding
LEGAL DESC:STR 11-29-01 W WM seismic creeks erosion f & w
LOT , BLOCK , TAX #
DESCRIPTION OF IMPROVEMENT: L%
------------------------------------------------------ c -------------------
BUILDING TYPE ...... :COM BEDROOMS--- BATHROOMS-- MAIN FL...: 800 sf
TYPE OF IMPROVEMENT:ALT EXIST.: 2 EXIST.: 1 ADDIL FL..: 0 sf
GARAGE/CARPORT.....: PROP..: 0 PROP..: 1 HTED BSMT.: 0 sf
WOODSTOVE...... ....: TOTAL.: 2 TOTAL.: 2 UNHT BSMT.: 0 sf
UBC OCCUPANCY GROUP: SEWAGE DISP..:CON OTHER.....: 0 sf
TYPE OF CONST......: WATER SUPPLY.:PUBLIC CRPT/GAR..: 450 sf
UNITS.: 0 STORIES:O HEAT TYPES.:EEE/ / DECKS.....: O sf
DIMENSIONS: -------MOBILE HOME------ COMMERCIAL: 0 sf
FRAME TYPE:WOOD MAKE: YR: INDUSTRIAL: 0 sf
EST COST.$: 5000 SIZE: BANK HT...: 0 ft
PROJ GRP..: 8678 SH SETBACK: 0 ft
----------------------------------------
Owner/agent
Signature:
Daae:
Issued By:
FEES
type
amount
by
date
recpt
PRMT
$
99.75
AK
11/13/96
1128503
PLCK
$
64.84
AK
11/13/96
1128503
B.C.
$
4.50
AK
11/13/96
1128503
Date:
�J� ------------------------------------
-X $ 169.09 TOTAL
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