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1309 OLYMPIC AVE
of ; Edmonds-
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RIGHT-OF-WAY CONSTRUCTION .
M. PERMIT
X •w- � — �� Permit Number.
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Issue Date: / --7
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890 _ 19°)�
A. Address or Vicinity of Construction: 1309 OtymDic Av (9617338)
B. Type of Work (be specific): j A A17 Sarvice S s p Improvement
C. Contractor: Washington Natural Gas Contact: Mariamne Kingsbury
Mailing Address: 1122 75 St SW . Bverett. Phone: 356-7500 X7596
State License #: 98203 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision
❑ Multi -Family ❑ Single Family
0. ' I INSPECTOR:
Side Sewer Permit # (if applicable):
❑ City Project Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Other
INSPECTOR: '� �I,�►c,��'I"�
F. Pavement or Concrete Cut: ❑ Yes 94No G. Size of Cut: x arge
APPLICANT TO READ •AND 46N
INDEMNITY: Applicant understands and by his signature to this application, agrees to ho the City o/Edmonds harmless from injuries damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any.legal proceedings including defense costa, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THEIFINAL
INSPECTION AND ACCEPTANCE OF.THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED'FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit require
available on..site at all times for inspection purposes.
Signature -
(Contr ctor or Agent)
CALL DIAL -A -DIG PRIOR TO BE
FOR CITYUSE ONLY
APPROVED BY: ,n _. iiIGHTOF
is and the pink copy of the permit will be
xINNING WORK
4>1 W q'
is ter,,
NO WORK SHALL BEGIN 'PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
.e 1
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments
Diagram;
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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��d� Sewer DrawingThe City of Edmonds EASEMENT NO- ----------- ----------------- --------------
2I 9 -- 019 0 0 NEW CONSTRUCTION RTJCi ION ❑ REPAIRS ❑ LID NO - ------------------ ASMT. NO...................
OWtNER------- -INTER---hi_. JIM, T-I ON------------------------------------- CONTRACTOR---------------------....-.-----------....------------------------------------------ PERMIT NO. --------------------
JOB, A]DDRESS------- 1.3.0 9---&l.,YW I G A ��a� LEGAL. DESCRIPTION: ION: LOT NO - --------------------------- --- -------- BLOCK NO. ------------------------------------
------------------------------------------------------------------------- -----------------------------------------------------------------------------------
NAMEOF ADDITION-----------------------------------------------------------------------------------------------------------------------
DYE TESTED OPT SEWER
PWW-0001-11/75 (REV.11/78) DATE ............................................ :3y....................................................
CITY OF EDMONDS
LOT APPROVAL STREET
A
NAMEC d . ADDRESS // 7 °'
ADDRESS OF PROPOSED BUILDING
LEGAL DESCRIPTION: LOT BLOCK ADDITION
TYPE OF USE NO. OF BEDROOMS SIZE OF LOT o k i 10
SOURCE OF DRINKING WATER: Public Supply, Private Well
a. SURFACE DRAINAGE
1. Is disposal field. site well drained?`e.�✓ ';'
Z. Any water course (stream drainage ditch, c.) through site?.
b. TOPOGRAPHY
1. Any heavy slopes in field,. area? 7,"
2. Will present topsoil in"field area be'removed or graded before -field tiles are
installed?
3. Will any fill material be used -in the disposal field site?' If'yes, how 'uchh
c.. SOIL CONDITIONS
1. Has a hole at least 4 feet deep been dug in the disposal field area to date
mine the type of soil present?
2. After hole., isdug-'record the soi conditions at the following depths. Record
as sand, ,gravel, clay, packed_ sand, loam, etc.)
12 inches 30 inches
ZS inches 36 inches ,
24 inches 48 inches
3. Any ground water encountered before• reaching 'th of 4 `f eet?
If so at what depth?
d. WATER TEST
A 6imple water test will show how well this soil will drain or percolate water.
To perform this test
1. Dig hole at least 36 inches deep. Use a shovel or post hole digger —
size of hole makes no,difference--only depth.
2. Fill hole with water. Now let"all water run out of hole. -This soaks
the ground and will give a more accurate reading.
3. Again pour water in hole to a height of 12 inches from the bottan. Let
water run out until there isjust 6 inches from bottom left in hole.
4. Note how many minutes it takes for this last b,inches to seep away.
Record this time below.
Number of' minutes for last 6 inches to seep away
_5. Divide this time.by 6 to obtain the rate per inch
6. Date water test was performed
I hereby certify the abo.ve information to be correct and -the -above tests were
performed by me as prescribed.
Signed ,
Address 1
NOTE: Aseptic tank permit is issued on the basis of the above information. "If
there are any changes or alterations in the above stated soil conditions lt'may
result in the instaLlation being rejected at the time of inspection.