Laserfiche WebLink
. . . � � �) <br /> SNOFtOMISH HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Court House, EvareH, Washington 98401 <br /> APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT <br /> (Submit 3 Copies) <br /> Permit to be issued to:..l�s7.1.�:.....7.."l.2ei.r...n..�........!_::ria�.f.Cr..«t e:.f!.an.......G�?.:...........................----......--.-- <br /> For installadon at: (street addmss)...�7..!/......�"^��:��� ....�.Cc!.�.,z.................................. <br /> Addicion or Subdivision..T�c.rq:�;...Pw,-/{.,f�c��_. ,,,.,� '�"��d <br /> . ..................................... Lot................ Block..../......... <br /> Type of Building: New.�..... Existing............ Single family residence.....X:...... Number of bedrooms...._..'-�-------------- <br /> Other: (apecify type or use)....................................�-•--�--�--.......................................................................................................... <br /> Builder.f![l�,f'�..T�tar�..n.�......C�u,.�s.�....._G.v.:._..Address..�3 n..;z.:....�,r..���c.t�a...<.�.!�.�..Y..._C.t/�f�7�'r <br /> '/ . r / . <br /> Designer.XY.4..n c� 1/ �v 'r — <br /> �e+.v.v- ..._�.'-¢....1...........�.Gdn�;e........AddIe35..�5'./0,..-27.�en:C:..�.^..> /l�. -��'r �'f;�P- <br /> ' - '••....................... <br /> ..... <br /> Soil Log Hole No. 1......._�..-..�f...��.....l.1.�P....�,¢r.�.............�-i.�-....�.�..�.....�.�v,-�.n........T..!..I.� <br /> _ -----_... <br /> .........-�--�-��-�-•--••.............................................................................................................................................................................. <br /> Soil Log Hole No. 2......Q....�_3_�r..._�.�f'J......���.'/.........3.�.:-....3G..�y......b.....✓�?.r,✓.n-.....T..t./�............. <br /> .............................................................................................�---......................................................................................................... <br /> Elevation of Water Table, if encountered. (Distance from ground surface)...................................................................... <br /> Corrections to control sutface water if needed........................................................................................................................ <br /> ---�--�-•--�--�--......---��-�..................................................................••---................................._.................................................................. <br /> Speci(y if any removing or grading of topsoil in field area....................................._:..................................---.............-.-.--..--- <br /> -�-•................................................................................................................�--...................._...................-�---...---........-� -............. . <br /> Percolation: <br /> Test Hole No. 1—Average Rate..�..Q.... (Fall in minutes/inch-bottom 6" test hole). Depth of hole.....-�'..rr.��..... <br /> r <br /> Test liole No. 2—Average Rate..l�... (Fall in m.inutes/inch-bottom 6" test hole). Depth of hole....3G <br /> Test Hole No. 3—Average Rate..�.... (Fall in minutesJinch-bottom 6" test hole). Depth of hole...34 " <br /> Average percolalion rate on which to base drain field design............./..d....................... Date taken..�/.1..���G.9 <br /> Septic tank requirements based on present rules and regulations: <br /> Septic Tank Size.......`„��.G?.............gallons. <br /> Amount of Square Feet of Di osal Field......'�.�.�......................... <br /> Signature — Designe��./.0:..�/�.�rc.:...................................... Date.'`�/L3�G._:�............ <br /> DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency) <br /> Permit issued (date)................. ...................................... ..Pernut Number................................................. <br /> Remazks:..._....-�................................................... ............................................................. ................................. ..................... <br /> ..................... �-� .................................................. --................._...................................................................................................... <br /> NeM 3sGao <br />