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17329 72ND PL W
APPLICATION
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SIDE SEWER PERMT
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The City of Edmonds S ET F�
NEW CONSTRUCTIONK REPAIRS E]
............
OV*rNER. . ........ <�7
ADDRESS ... . ...... IZ2 .......
BASEMENT No . ..........
CONTRACTOR ........... PERMIT No . ......................
LEGAL DESC RIPTION: LOT No . ..................... I ... 5 ...................... BLOCK NO . ............................................
NAME OF ADDITION ........... .....................
..........................
7,3 ,-�
Approved:
DATE................................................ By ......................................................................
APPLICATION
The City of Edmonds for EASEMENT NO - ---------------- ............... -----------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS LID NO. ----- ASMT. NO...
OWNER ..... Fv---f Y ------ . ....... CONTRACTOR .................................................................................... PERMIT NO . ....................
JOB ADDRESS ---- k -1 - -i - \,t-) - 7E-�> -------- BLOCK NO . ....................................
-------------------------------------------------------------------------- ...... LEGAL DESCRIPTION: LOT NO - ------------------------------
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NAME OF ADDITION -,j kt-zNN �- AVH \ < -- -1 V A7 I :---: - I
...................................................................................................................
Approved:
DATE .........
7�1
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The City of Edmonds
APPUCATION
for
SIDE SEWER PliRMIT
NEW CONSTRUCTION El
OWNER
JOB ADDRESS 1-7 -A-L� - ----- 715d
wkw EASEMENT NO - ------------------- ------------------------
REPAIRS Ej LID NO. ---/4-4--.ASMT. NO.
---------- CONTRACTOR ............... ------------------------------------------------------ ------------- PERMIT NO.
LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - -------------------------
... �5 -- ----- - - C�D-u vi d U t'e . ....... t,( e 'k 5
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DRESS��L-OCA-1-ION��'OF,�itONSTRUCTION�, ..................... ......................................
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CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Subinit in Triplicate)
ADDRESS OF PROPERTY ...... 17.32.9 ..... ... 7.2nd ... Pl.ac.e ... W* ......................... I ..... Lot No ....... 5 ............ .' Permit No ...... �4.3 ....
. .. .... I . .. .. ....... .. .. .. . ..
Owner .... Peter.'H. Gaertner 17329 - 72nd P1. W. Phone ....... ................
. ..... ... Address .............. . . .........................................
Builder_ ----- same ................................. . ........ Address ........................ ........... ........ --------_-------_-- Phone ........................
Designer---- ..s.ame . ................................ ................. Address ........ ................ .................................. ..... Phone .......... .............
Installer AiOPPIIO.ConcretA TXo4o ..... . Address. .... ... ......... ................................... _ .......... Phone ........................
1 hereby certify the accompanying drawing is an accurate representation of the system installed at the listed
address. I also certify all recommendations and restrictions (concerning plumbing stub elevations, maintenance of
grades, fills, Surface drains, etc.) listed by me on my sewage disposal system permit application dated .... -----------
. ...... Auly. --- 9.p_1969 .......... have been complied with.
............. .......................... ................................................ ............................
Signature of Designer Date
TO BE FILLED IN BY CITY ENGINEER ONLY
Accepted...................... X ....................... ............... Date ---------- 7/15/0 .......
Not Accepted ........ .....Date . ..........
4��7 . .. ...... �... V ...........................
Signature of Sanitarian .......... �.
Remarks: .............................................................. ...........................................................................................................................
INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest
detail and still contain the entire site on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to care for an average -size family. Over-
loading the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to
remember:
I . Have your tank checked periodically to see if pumping is necessary (2V2-3 years).
2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield.
3. Do not excavate, fill, place a structure, driveway or, patio in, on, or over the drainfield.
4. Limit toilet fixture disposal to sanitary wastes and toilet tissue.
5. Detergents and bleaches used in normal household quantities will not hariii tile action of tile septic tank and
disposal field.
SEWAGE DISPOSAL PERMIT
Septic Tank ........... 777 ....... gals. No . .....
CITY OF EDMONDS . ...............
Department of Public Works
Disp. Field ..... ...... sq. ft.
Other........ .......... .............................
/.-" . ..........
............ .................................. ......................................................... is hereby authorized to install/
repair sewage disposal system at
........... ......... ------ ... ..... - — - - - --------- - ................................................................................... .................
Date issued on... . .......... .......... i .....................................
A.
Permit expires on , e year from date of issue
DO NOT COVER BEFORE APPROVED BY DESIGNER OR SANITARIAN
I hereby certify- this system was installed under -my supervision and control and, complies �vith all provisions of the City�
of Edmonds Resolutions.
Signatureof Installer ............ .............. . ......................... .............. Date ....................... ...........
ApprovedDisapproved E] Date. ............................. ................................. By ............................. ....................................................
Remarks: ---- ..................................................................................... I ...... ............... ................................................................................................
"SANITARIAN, OR DESIGNER ............ ....................... ....... .......... ............ .............................. Date ..........................................................
This permit ihall be posted in a reasonably conspicuous I place on the Job until ins�e�tion has been completed.
CITY OF EDMONDS
ENGINEERING DEPARTMENT
250 Fifth Avenue North, Edmonds, Washington
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3,-Copies)
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Permitto be issued to: .......................................................................
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For installation at: (street address) ....... --------- ............. ...................................... .........................
Addition or Subdivision,����� - - ............................ Lot ...... 67... Block ................
Type of Building: Existing ......... .-. Single family residence ... ...... Number of bedrooms ..... 13 .................
Other: s ecify type or use). ............................................................. _ ....................
A - ,
t
....... -----------------------------------------------------------
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V% le �o Address
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Builder....................................................................
.......... ......... ----
..........................
.........................................
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Designer......................................................................................
Address ...............................
N k
I—, ...... ............... I., ................. I ---------
Soil Log Hole No. ... . .... F .....
�ai�
sa. - 4 0.
... . ........ rj.!f ........ SA ...... C7. Z .................
�J� ---- — ----t ............ I
............ %5A�.461.9-
......... ................
...
Soil Log Hole No. 2 ...... 0 .... -.? ............
7o.F,
----- -- .5.4-V ......... I— ...........
le .. .......
Sa
.......... 41 ..............................
.. .. ..... 0
I/
3 ..... .. 3e ........... 1.5A.--Ga
..............................................
...............
.......... 0910_ ............
;r
r - C 14a
. ................. / ..........................
Elevation of Water Table, if encountered. (Distance from ground surface) ..... . . .. . . .. ..... .... ...............
Corrections to control surface water if needed ........................................................................................................................
Specify if any removing or grading of topsoil in field area ... .................................. . .... ..................................................
Percolation:
Test Hole No. I —Average Rate ..... lAmt ................. .. (Fall in mimites/inch-bottom 6" test hole)
Test Hole No. 2 —Average Rate_+�.��..ar.. M__)yr ........... _ .... (Fall in ininutes/inch-bottorn 6" test hole)
Test Hole No. 3,—Average Rate.4-5--Aar Mily. -bottom 6" test hole)
. ........ 11 ... I .............. ....... ...... (Fall in minutes/inch
Average percolation rate on which to base drain field design ... _4 -15' .. 9
... I ... I ....... I . .............. Date TakenJ ... ....
Septic tank requirements based on present rules and regulations:
_0')n X�v 44
Septic Tank Size ......... T. -1 ........... gallons.
Amount of Square Feet of Disposa i . ........ ... ..
............ ................................. .. .. Date
Signature — Desl ;er7 ..... 0-P .................
eld
igr..... .........................
DO NOT WRITE BELW THIS LINE (To be completed by ISSUing Agency)
Permit issued (date) ..... 6-f ............. Permit Number ....... ... .... .........................
Remarks: ........... ............... ......
. ...... ....
...... -------
. . . ................ .....................................................................
................................................................................................................... . ................... .................................................................
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