HomeMy WebLinkAboutBLD92-0896 POLE BLDG - BLD Permit / Conditions - 9/9/1992 .w
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NCRETE �H�N CAL MOBILE HOME
6y Ribbons
date by by :j:d:
Gas Piping
Set Up
Foundation Walls date by date by
date by INSULATION Final
BG/SLAB Insulation Floors date by
date by date by FIRE DEPT.
FRA ING Walls date by
date by date by OTHER
PLUMBING Attic
Gro wor date by
date by WALLBOARD NAILING
D.W ✓�✓� by1V 1�J date by
dat FINAL INSPECTION
Wat r ine date by date by
date by
M1 __ PERMIT NO. _._ D
Sb�V BOUNTY PARTMENT OF HEALTH SERWICES
• SITE EVAL ATI DESIGN A D INSTAL TIO'J co
Q� I m
j Date �7' r Date v
�26 W.QEDAR/P.O. BOX 186/SHELTON,WA 98584 0 o
`„RHONE (206) 427-9670
Receipt No. ft Receipt No.
4 Amount$ Amount$ z
p DATE: m cm
=. � tea: CHECK APPLICABLE ITEMS 1/ B <
tember 1992cn m
� h INSTALLING NEW SYSTEM v
M ILI E DAYTIME PHONE
REPAIRING OLD SYSTEM
INA 3'
�^ EXPANDING SYSTEM
OI'rY� �� ST `I'E1 s;
. 5� .. SINGLE FAMILY
PROPERTY ADDRESS: OTHER Z c
SPECIFY: R
Take ba )ort Rd. � mile past Correction
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL Cr
m
PUBLIC SYSTEM
SYSTEM ID NUMBER
Center--Turn Right--turn left at top of hill. Go SYSTEM NAME IN
past 2nd. Ural-De—Sac--second lot past Cul—De--Sac APPLICANT
NAME
Name of Lot 330 1 ft.x 330' fL MAILING ADDRESS
Installer I"
Size: 2. 5 acres TELEPHONE 0�, 1
Name of Number of SIGNATURE
Designer
Bedrooms 3 3 IX
PLOT PLAN � -
Draw a dimensional plot plan, �•�j
including: p
Precise location of test T4 1'� , x
holes,'showing
measured distances to 4
Jb
property boundaries.
❑Entry road;other roads,
driveways.
NOTE: DO NOT DRAW IN
- SYSTEM DESIGN
OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOG �"w3
L&AYK%,! s �
kerrs -to
1614
E t1w Depth from Original
€ Grade to Restrictive
Layer or Water Table: `
DESIGNER DESI NATION SCORES MINIMUM SYSTEM REQUIREMENTS
r Design:*evel One U Level Two
Soil
Vertical Separation Septic Tank Daily
Slope Capacity: it Gal. Flow: �60 GPD
Appl. q► GPD/FT2 Infilt.Area ep from Original
Parcel Size Rate 0 r Q ��� FT2 Grade Bottom of
Absorption
tion area: I
Distance to Shoreline Total Inspector Date
COMMENTS/CONDITIONS FOR APPROVAL
[IN Pa&1- 1_/4 - g-748 6e.S.
r
❑Owner/Designer/Installer must meet on site to verify precise system layout ❑Owner must arrange pre-installation conferences with health dept.staff
0 Winter observations required O Extreme care needed during site preparation to preserve existing topsoil
Any change from the specified use of the property or any site alteration affecting the system design may invalidate this permit.
This Permifexpires 3 years from date of Issue.Denial of this permit may be appealed to the Health Officer within 10 days of denial date
l n Require
SITE: Approved d U Not Approved ❑ ❑DESIGN: Approved Not Approved INSTALLATION:❑Approved ❑Not Approv
' BY: CPA DATE:/v..4,q BY: DATE: BY: DATE:
TOP Health Dept. Copy MIDDLE: Designer's Copy E30TTCM;Applicant's Copyy