HomeMy WebLinkAboutSEP1970-00014J
SEPT ' 04Ar
03 East East Caro -line OLYMPIC HEALTH DISTRICT Permit No.. __�?��
Port Angeles Fee Paid $, ■_..` /
SEWAGE DISPOSAL PERMIT APPLICATION/
Submit in - Duplicate
• • - �rrroi nr rr..rw.r.
NAME ��0 �4 RE�sS �; DATE / .9.-
Ir i. 1 .' �� rOr.YYrY1r 1 ir.11--�..�.
LEGAL DESCRIPTION ` Zo;- /� &.C®e_fc i® t y, c�C � PHONE �S'
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DIRECTIONS FOR LOCATING SITE.Lal4�u 'C
■rl■�...:�.�rn. Ir.iirwr■��.rr fr-,....rr.�r.�ro.a.
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEN I,/REPAIR EXIST33G SYSTEN!
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Mes; .0e� e --e ��-, Z0c3® .5* 1�j�2. PP. L��✓a�S�1
YPE OF BUILDING NO. OF BEDROOMS BASEMENT SITE SIZE NAME OF INSTALL
,.-y u -u rZme re qua -red to
Pers. No, 1
of hole seep last 6 in.
_
Pere. No 2
Pere. No.
Percolation rate
(divide time by 6)
DRAINFIELD LENGTH 1®4) '...WIDTH w,EPTH `3.� NO. OF LINES...., -4.
IT IS HEREBY AG D THAT THE PROPOSED INSTALLATION. WIT�L BF MADE :15 THE MAFINPIi3
AS DESIGNED AND APPROVED ON THIS AIPPLICATION.
APPROX. DATE, OF INSTALLATION=.22 -� � ?
-..rr1�.11r1
SANITARIAN'S COMMENTS:
Signature of ,Applicant
APEPMTm leRITAT rtt+n T mtt .,,tn r.,n-,, w..w�. n .w.w.- w ,� v • .. reTTT/�tf .
PLAN APPROVEDD� DISAPPROVED DATE I..30-70
DATE. ZNSPECTED A %--7
REMARKS: -
5-68
SANITARIAN`.
j
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rJJA1V U.L V.L1W J JIPj V W"V WJX1%x J-JYr,vlWAftA.Lw
le
Property
lines =:-: +: 17*'D
Dom mays' patios I carport,, etc.
2.
Location
of building
8*
Streams or bodies of water nearby
3e
4.
Location,
Location,
of septic tank
9.
Location of percolation test holes
of drainfield
10.
Septic tank size /0,0 0 gallaw
5.
6,
Slope of
Water
landlle
Length of.proposed drainfield
lines.& well(if applicable.)
12.
Depth to water if encountered.
.PERCOLATION
TEST
RESULTS
,.-y u -u rZme re qua -red to
Pers. No, 1
of hole seep last 6 in.
_
Pere. No 2
Pere. No.
Percolation rate
(divide time by 6)
DRAINFIELD LENGTH 1®4) '...WIDTH w,EPTH `3.� NO. OF LINES...., -4.
IT IS HEREBY AG D THAT THE PROPOSED INSTALLATION. WIT�L BF MADE :15 THE MAFINPIi3
AS DESIGNED AND APPROVED ON THIS AIPPLICATION.
APPROX. DATE, OF INSTALLATION=.22 -� � ?
-..rr1�.11r1
SANITARIAN'S COMMENTS:
Signature of ,Applicant
APEPMTm leRITAT rtt+n T mtt .,,tn r.,n-,, w..w�. n .w.w.- w ,� v • .. reTTT/�tf .
PLAN APPROVEDD� DISAPPROVED DATE I..30-70
DATE. ZNSPECTED A %--7
REMARKS: -
5-68
SANITARIAN`.
j
T.
II.
ON-SITE SEWAGE DISPOSAL SURVEY OF
Street Or
Division Block Lot Landmark
Location, Lot Size D Q ' QSx tam
System Owner
Address
Tel ephone Number
Permit (?) (Previous Owner)
D t I5 d �g��
Lot Size
a e sue
TII. Installer Average Number of People Served
Date Installed q`Z Number of Bedrooms
Time In -Service (years) % O Clothes Washer
YES NO
Septic Tank Pumped x
YES Nd 'HOW Dishwasher
OFTEN YES NO
# of Months/Years Residence Occupied? Garbage Disposal
YES NO'
I11. Type of cover over drainfield. (i.e. grass, landscaping, etc.),
V. Repairs (when, what, who) Cause of Failure