17727 69TH AVE W.PDFIIIIIIIIIIII
5289
17727 69TH AVE W
Side Sewer Drawing
f r-.J -1
Ify 0 Mull b EASEMENT NO - ------ -------------------------------------
'0r7
NEW CONSTRUCTION CK REPAIRS Fj LID NO. �A -------- - ASMT. NO. � -----------------
4. P.
OWNER ---- ------ B;� --- -------------------------------- CONTRACTOR ..... <>4V-h-JZaF� - ------------------------------ ..... . ............. PERMIT NO.
JOB ADDRESS - - ------------- LEGAL DESCRIPTION: LOT NO. LST7M�-- � -- BLOCK NO . ....................................
0
PWW-0001-11/75 (REV.11/78)
..................................................................................................................................................................
NAMEOF ADDITION ............................................................................................... -- - -------------------
Approved:
'-7
DATE.... ..... By .... .............................
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CITY OF EDMONDS
PUBLIC WORKS DEPARTM *
SIDE SEWER PERMIT
FOR INSPECTION CALL
775-2525 Ext,,-,,,2ZQ—
Permit
_Igsue Date - 71
PERMIT MUST BE POSTED ON JOB SITE
1. Address of 7wonstruction 1/772-7 -V W. 9uao
2. Proprerty Legal Description (include all, easements)
(A -qCZ6 ocl � . 11
3. Sing�le Family Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder
5. Contractor & License No.
6. Invasion into City Right-of-way: No P'� Yes (if Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer con xa-ItI&T nw��It
construct side sewers in the public' right- f,-�wa
DIAL -DIG
b. The side sewer contractor assumes 14.1 s bi ity8foAsea,,h
installation for one year.
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BEFORE
C. Commercial establishment requires in 0 q")
sifibOrM
side sewer line.
d. Sider'sewers may not be installed c 0 n irty i. hes (30"
to any structure.
e. Side sewer lines must be laid -at a H 0
and maximum grade of 100% (450). MITY OORDINATIN6 COUNat
f. No turn in side s8wer greater than Lit -Wal 0 allowea
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and Wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for ri . ght-of-way failure
due to poor compaction of fill.
k. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE: 2 0
I certify E—hat I'have read
and shall comply With the above
Lw:
000� I
-3 5, 0 C5 K-11 Vm",_c t
PERMIT FEE:— OISAPPROVE D BY: Date:
60
By: Date:
CONNECTION FEE: 1AM - 0,�) R(
94 ROVED By: Date:
0 z b�,4�� oF
P4 4 111� V,___ (_ Cd ��e
ERMIT MUS
P T `B E POSTED ON JOB SITE
R CEIVED
SIDE''SEWER PERMIT
CITY O.F EDMONDSC 1,, 11993
PUBLIC WORKS DEPr
8 9 0 -1 9 P&m,T'.N2 .8-5 aA.
Address of C . onstruct'ion: �7'72 -7 tA Z
Property Legal Description (Include all easements)
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Owner and/or Contractor:.- 7
k 14 50 L Buil ding Permit No.
State License No. 5,6,
9"S0
ingle Family
Multi -Family (No. of.Units
O.Commercial
El Public
Invasion into City'Right-of-Way: Ei""No E3 Yes
RW Constructicin Permit No. -
Cross other Private Property: P/No -0 Yes
Attach le pL4,aseripficl"n-d-copy of recorded easement
I certify that I have read and shall comply with all city requirements Date
as indicated on the back of the Permit Card.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY'E,XCAVATION
USE ONLY
FOR INSPECTION CALL 771-3202,- PUBLIC. WORKS-DEPT.
Fermit Fee 30, DO AP,4&),,I00 issued By
27 -o5�?
Trunk Charge . .4 /0 /
/Y Date1ssued:
Assessment Fee: Receipt No.:. Z:7� 5pe
Lid No.;:
Partial Inspecti,on: Date Initial -
Comments
Reason Rejected: Date-'Initial-
N,&- Co-t 4ed �7,iiL 7r
Final. I nspiection Approved: Date I'nitia'l
PERMIT MUST BE POSTED ON JOB SITE
WhIte.Copy: File 6reen copy.: Inspector Buff Copy; Applicant
Revised 3190
-1
4
The City of Edmonds
Side Sewer Drawing
EASEMENT NO . ............................................ '%
NEW CONSTRUCTION Ej REPAIRS LID NO
. ................... ASMT. NO . ..................
OWNER.. ................. .............................................................................
CONTRACTOR .................................................................................... PERMIT NO. 8�-1.4-
JOB ADDRESS Ll --/-- ;0,777:Ze IT14 ...
.... tv"v ----------
LEGAL DESCRIPTION: LOT NO . ......................................
BLOCK NO . ....................................
--T7y,j -c, R, fk S
(D
PWW-0001-11175 (REV.11178)
NAMEOF ADDITION .......................................................................................................................
Approved:
2_
DATE . ..................... ..... ( ......... By
DATE: '111,
MEMO TO: John B REET FILE
,�,Mitchell, Supf;T
Water ewer Division
FROM: James E * Adams, P.E.
City Engineer
SUBJECT: SEWER CONNECTTON CHARGES
177 7 Z -7 45;57 4 -AQ6 0&4— LLJ
(Street AddressT —
ON -97�-� �." - - - � I
(Legal Owner)
Single Family Residence Subdivision
PRD Multiple Commercial
LEGAL DES�CRIPTION:
Plat
Z.F.F. Calculation:
Z. F. F. x $ `5' Connection Fee
Lateral x( $ Lateral Charge
Equivalent Count
$ (when applicable)
Units(s)x( $25.00) $ -S - 1501 Trunk Charge
$ 10.00 Permit
$ TOTAL
j ak
cc: Owner
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Fi. Co
FCM COWMBIA ESCROW CO., INC.
ri- 2150 North 107th Street, Suite 170 P.O. Box 33670
(206) 36S-9400 Seattle, Washington 98133
April 17, 1980
JIM ADAMS
City of Edmonds
Engineering Department
Edmonds, Wa. 98020
RE: Escrow #9834 House/Bare
Gentlemen:
This is to certify that at the time of closing of the transaction
on property located at 17727 69th Avenue West, Edmonds, Wa. 98020,
we will disburse $ 1181.09 to you for payment in full of the
sewer connection assessment.
B. Drouin, Escrow Officer
The undersigned certifies -that sewer has been connected to subject
property and that the above amount is correct.
City of Edmonds, Department of Engineering
AFAIME11.0- WAAZA'A1@—Kdi'
T�w s-
8 e e LAJ 0A P,
THIS SPACE RESERVED FOR RECORDER'S USE
SECURITY TITLE INSURANCE COMPANY t�HISS
CO OF WASHINGTON
\sracuRrry/
1109 SEC11�0 11CNUC . SlITTIE, -^S-IIGTON 90101 - -11N 3-0610
C\j
Filed for Record at Request of
NAME
ADDRESS
Advance Nnrtp�n.,,,e Corporation
2200 Sixth Avenue
CITY AND STATE Seattle, Wa 98121.
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STATUTORY WARRANTY.'DEED
PCCORDS
00
THE GRANTORS, GEORGE H. ALBERTSON 'and VIRGINIA E. ALBERTSON, his wife
for and in consideration of TEN DOLLARS AND OTkR GOOD. A.ND VALUABLE CONSIDERATION
in hand paid, conveys and warrants to VE RNO�'- L': BARE... an.d. . LAURA. J. BARE, his wife
as Grantee, the following described real estate, situate'd in the County. of
State of Washington:
East 80 feet of the West 259 feet Of Tra'ct 154',*Plat of Meadowdale Beach�, as per
pint rerorded in Volume 5 of'P . I I t s on., page 38, records of Sno>mi.�h County, as
measured from the West line of said tract; 'EXCEPT the North,"467 feet as measured
from the South line of road; TOGETH'ER - WItH easement for road and utilities over
the South 20 fc ' et of said Tra-c—t-1-54 running from the East line of property described
above to Edmonds-Bcvcrlv.Pirk �Road'lying,adjacent to East liiIe of Tract 154: situate
in the C-oi-in—ty* 'o'-f "S'"n",o-h*"o--m--'i',',,-Ii--*,-'-S--t-,l--t'-e-'--o�� Washington.
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CHISO.LAWSOF1935
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CM.180.LAWSOFIM
PEAL E'STATE SALES TAX
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SURTECT to easements, restrictions and reservations of record. F�7PU
Dated this 23rd
STA-fE OF WASHINGTON
County of K I NG.
On this 24th
day of �Tay, 1972
(SEAL)
EORGZ/11. ALBI�9TSON,,---
(SEAL)
VIRdINIA E. ALBERTSON
ss.
day of �f,,Y, 1972
, before me, the
undersigned, a Notary Public in and for the State of Washing!on, duly commissioned and sworn, personally appeared
GEORGE H. ALBERTSON and ViRCINIA E. ALBERTSON
to me known to be the individual describ'�d in and who executed the foregoing instrument, and acknowledged to me
that t lie ,r signed and sealed this said instrument as free and voluntary act and deed for the
their
uses and purposes therein mentioned
GIVEN under my hand and official seal this 24th
1 j/67
2246181
Nlavl 197Z------
AWai-y-Public in and for the i
residing at
Seattle
0
� VOL 098 i.�Iu �93
C
A
STREET FILE 17-
. critical Areas Checklist'
Site Information
AProject Name: Per m,it Number -
Site Location: Property Tax Account Number. 1c)
Approximate Site Size (acres or square fed):
Have you filled out a Critical Areas Cheddist for a prqjcct7on'�is site b-cforc?
General Site Conditions
L Elas the site been cleared or logged? Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Desmibe, the general site topography. Check all that apply.
(!,-I Flat: less than 5 feet elevation change over entire site -
Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
Ifilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of horizontal disunm)
4/9
t teep: gradesof greater than 30*/,* present on site.
Comments
Hydrology/Vegetation.
4- Site contains areas of year-round standing water
S. Site contains areas of seasonal standing water- Approx. Depth:
6- Site is in the floodway floodplain zt-1,1� of a water course-
7- Site contains a creek or an area where water flows across the grounds surface? flows
are year-round? Flows are seasonal?
. ..... .. ........
e. S:st6 Js*
rj C�il.2 hot re�uired.
:.---:VVAIVER--:C u
..!Y
n Number
Determinatio Reviewer
Planner
Rev W2 M 2
City of Edinond S-
C I I
rkkaf Areas Ch'eckfist
Thc Critical Ar=s ChacMist contained on
d1iS form is to be filled out by any person
Prquring a Development permit.
Application for the City of Edmonds prior
to his&cr sfibmittal ofa development pc.*
to the City -
The Puqx= of the Chceldist is to enable
Q1Y staff to determnewhether my pot,=tml
Critical Arcas am or way be present on the
subject PrOPCItY. Ike information needed to
COMPIcte the Cheddist should'be easily
a 'la
v= ble fiUM observations of the site or
data available at City Hall (Critical Areas
invcntOrics� maps, or soil surveys).
An .1pplicaut. or his/her representative, m=
fill cut -the checIdist. sign and date, it, and
submit it to the city 7he City Will =view
the choddist. a prccmrsory site visit,
and m2dw a determinationof1he Mbscqucnt
steps necessary to Complete a development
permit application.
With a signed copyof this &rm� the,
aPPlicant should also submit a vicinity map
Of the Parcel Vith enough ddA that City
staffcan find and identify the suldect
Palcd(s)_ In addition. the applicant is
encouraged to include any other pertinent
information or swdics in conjunction with
this Chc6dist to assist staff in completing
their preliminary assessment of the site- .
I have completed the attached Critical Area Chccldist and attest that the answers provided "are
factual, to the best. of my knowledge (fill out' the appropriate column below) -
Owner / Applicant:
Name
I Tilde
1 Street Address
City. State. Zip
Phone
Signature Date .
Applicant Representative:
"Oe
Name
cra�p-
Title
Street Address
_!; eo— --1. 5 -5
City, State, ZIP 5`19
Phone
Signature Date
STREET HLE
COLUMBIA ESCROW CO., INC,,0.;.
2150 North I 07th Street, Suite 165 P.O. Box 337�5
(206) 365-9411 Seattle, Washington 9§,rt3�,,
4/23/80 ot
City of Edimnds
Engineering Department
EtImands, WA 98020
Attn: Jim Adams
- RE: Your: -17727 69th Ave. W-.,-Edmonds - Vernon L. se Laura J. Bare
Our: Escrow 9834 House
Gentlemen:
Enclosed is our check for 1,1R1.0q in your favor to repay your
encumbrance in full. VSEE ec-CiET-PT
Please forward the following: q0 �jo - 4232 9
_WSFC_ s(oc- saw e6a
Guarantee of Satisfaction7immediately) Pa-z_em-ii- Ajo.
Release of mortgage
Warranty Fulfillment deed
V/ XX Please send us a receipt for payment in full; also reference
our escrow number. Thanks!
Please submit any fire insurance policies you hold to agent for cancellation
and direct any unearned premium to the above -referred seller at:
17727 69th Ave. W., Edmonds, WA 98020 Please ask to have forwarded, as
we don't have another address for them at present.
Very truly yours,
COLUMBIA ESCROW CO., INC.
BY
Ar
Betty grouin
4L,39 coo
CE 105
diZ
__ .
- 114.
^ V,
Name Account
Escrow No.
Date
Check No.
Amount
PAY
TO THE
)RoER OF/
COLUMBIA ESCROW CO., INC.
8860
TRUST ACCOUNT
2150 N. 107th, SUITE 165 - SEATTLE, WA 98133
19-119/1250
PAY
.................
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COYIV M[311,�A,�jESC2R VV 0., INC.
TRUST YN'
,ACC
�g NIT
Auro,a Branch
Seattle -First National Bank
Seattle, Washington
11800088601" 1: 1 250-0 1 L91: 6 260 9 13,10
STREET FILE
CITY OF EDMONDS
250 - STH AVE. N.'- EDMONDS, WA 98020 - (2061774-0220 FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
-?8 C) Z) Public, Works e 'Planning o Parks and Recreation e Engineering
LE=R OF TRANSAI=,AL
Datez August 13, 1993
To: Keith Ellis
735 N.E. 198th
Seattle WA 98155
Subject: CRITICAL AREAS CHECKLIST
Transmitting: CA-93-202
For your information:
As you requested:
For your file:
Comment and return:
Note attachments:
Comments:
**YOU MUST BRING A COPY OF YOUR CRITICAL
AREAS CHECKLIST WHEN YOU SUBMIT YOUR
BUILDING PERMIT APPLICATION"
Planning Division
Diane Cunningham, Planning Secretary
LAURA M. HALL
MAYOR
o Incorporcited Au-qust 11, 1890 0
Sister Cities International — Hekinan, Japa n
CRY of Edinonds
Critical Areas Checklist
TLe Critical Areas Climuia contained on
1his fibrIn is to be filled out by-;My--Dcrson-
prqnring a Dc4qp
Mcntpermit
APP"cafiOn for the CitY Of Edmonds prior
to his&cr s6butittal of a development permit
to die City -
The purpose of the Ched-jist is to enable
City staff to dewminc, whether any potential
Qitical Areas am or may be present on the
subject property. ne information needed to
cOmPlete the Cheddist should be easily
avmlable from observations of the site or
data available at City Hall (Critical Axcas
inventories, maps, or soil surveys)..
An applicant. or histher rcpresentative
,. must
—,fill out the cheddist.-sign and date it. and
submit it to the City- I he City will review
the checidist. in a precursory ift- Visit.
and rualm a detcrmination of the subsequent
stcps necessary to complete a development
Permit application.
With a signed copy of this form� the
aPPlicant should abo submit a 'Vicinity
Of dLe parcel Vith enough debul am City
staff can find and identify the =bjcct
parcel(s)- In addition. the 2pplicant is
encouraged to include any other pertinent
information or sttidies in conjunction with
this Chccklist to assist staff in completing
thei . r PrellmlnarY assessment of the site -
I have completed the attached Critical Area Cheddist and attest that the answers provided -are
fictual. to the best of my knowledge (fill out the appropriate column below)
Owner/ Applicant:
Applicant Representative:
Nam 1Y
Name
7-1de
Title
Strect Address
Street Address
City. State. Zip
Phone City, State, ZIP
Phone
Signature
Date Signature* Date
Critical Areas Checklist'
Site Information
Project Name: A"V Perml*t Number.
Site Location: -.Aci L-e- (-U Property Tax Account Number.
Approximate Site Size (acres or square feet): 'KC'ZW & &,
7 r
Have you filled out a Critical Areas Checklist for a projedon this site before?
General Site Conditions
1. Has the site been cleared or logged?_ Date of most recent action:
Soils I Topography
2- In the Snohomish County Soil Smvey, what is the mapped soil type(s)?
3- Descri-be the general site topography.Check all that apply.
C—) Flat: less than 5 feet elevation change over entire site-
I'LL Rolling: slopes on site generally less than 15% (a vertical rise of 10 fcct over a
horizontal distance of 66 feet.)
13r. slopes present on site of more than 15% and less than 30% a vertical rise
of 10 feet of horizontal distarim)
4-ld -Stecp: grades of greater than 30*/* present on site.
Commcnts
Hydrology/Vegetation.
4- Site contains areas of year-round standing watcr-
5. Site contains areas of seasonal standing watcr- Approx. Depth:
6- Site is in the floodway Z4,'dI floodplain of a water course-
7- -Site contains a creek or an area where water flows across the grounds surface? - flows
are year-round? Flows are seasonal?
8- Site is primarily: forested meadow shrubs mixed
9- Obvious wetland is present on site:
10. Wetland inventory or map indicates wetland present on site-
11. Critical Areas inventory or map indicates any Critical Area on site:
For'City,Us'e-061 y*
Rcy M 7/9 2
SMEET FILE
USE PERMIT
CITY OF EDMONDS ZONE&< NUMBER 930649
CONSTRUCTION PERMIT APPLICATIOIN. r
OWN9R,NAMEJNAME OF BUSI�IESS 7 "00SRESS J 7 7? -7 c, 9 A ug w
1 / Zao(t 4eq-1,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
:XISTING — REOUIRED DEDICATION
ROPOSED
TESCP App,oed 0
R Pe —It Required 0
sw
treat Use Parrid Rect'd 0
Inspection Required 13
Sidewalk Required 0
CITY
TtLEPHONE NUMBER
NAME
1
,ZKS
R7
ADDRESS
64—AZ6,1_:5
L)
X
4
CITY ZIF_7ELEPHONF
NUMBER
AO^ ( q /? 4
NAME
a:
0
ST4r k/=
ENGINEERING MEMO DATED 13Y
ADDRESS
METER SIZE
ING SUPPLY SIZE
7
2
Z
INO.OFFIXTURES
CITY TELEPHONE NUMBER
SeA _7
63-5757
REMARKS
8
STATE LICENSE NUMBER EXPIRATION DATE
tot
SIGN AREA
SEPAREVIEW
A
Z
ALLOWED PROPOSED
COMPLETE EXEMPT
EXP :
;71;�
SH09 TLINE
X
Legal Description of Property - include all easements
zoy
VARIANCE OFI)CU
All A__
ING law
By
SETBACKS — FEET HEIGHT
FRONT IDE Z REAR
LOT CO WGIE
53V-_2'
0
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Property
Tax Account
Parcel No. 111�0 0 — _/ 0
HkMAHK5
[:1 NEW ETRESIDENTIAL PLUMBING
ADDITION El COMMERCIAL MECHANICAL
REMODEL El APT.BLDG. SIGN
CHECKED BY
TYPE OF CONSTRUCTION CODE
q)
HEIGHT
GRADING FENCE
El REPAIR D CYDS. 1 x _FT)
DEMOLISH OODSTOVE sw OOL
1:1 INSERT HOTIMTLB/SPA
GARAGE RETAINING WALL/
CARPORT ROCKERY RENEWAL
SPECIAL INSPECTOR
R QUIRED
E
13 YES
AREA OCCUPANCY
GROUP
82
0 CCUPANT
LOAD
MARKS
Z
0
a
M
0.
ITYPE,�US ESS OR #CTIVITY) EXPLAIN:
E'T
NUMBER N WUIELLEIR CIF
0 N ]CRITICAL
SF 0 AREAS. il'?_
TORIES U NUMBER
OESCRI84 WORK TO BE DONE JATTACH PLOT PLANf
PROGRESS INSPECTIONS,PER LISC 305
000f hyW'U�W, ,04
/C Cjr I, —
FINAL INSPECTIUN RF.UUIKF.0
VALUATION
FIE
FEE
PLAN CHECK FEE
-DING
H AT S UR
GLAZING
%
PLUMBING
......... . ...
1 17
Plan Check No.
93 -/(:�2 /
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (Curbs, sidewpiks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Applicallon: 190 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
90
0
Successors in Interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its Officials,
employees, and agents from any and all Claims for damages of
715-.
PLAN CHECK DEPOSIT
whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
01
OX
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
9c) 0
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
information given IS Correct; and that I am the owner, or the duly k-will a
authorized agent of the owner. I agree to comply with city and, THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authorlz. AUTHORIZES
ad thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa. WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance. INSPECTION acknowledged in space provided.
- SIGNATUR low A AGENT ]DATE SIGNED DEPARTMENT I IA . I N TURE DATE
CITY OF
EDMONDS
CALL FOR A E
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A F:NAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW — In'sPSCtor
A CERTIF CATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — AsseSSOr
a
9
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7,;2 1 'lPe L---7
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APPROVED BY PLANNING
za'
SNOHOMISH HEALTH DISTRICT
DIVISION OF SANITATION
3011 Rockefeller Avenue, Everett, Washington
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3 Copies)
Permit to be issued to: ........... �T?�SA --- �ajlawall_j ..............
................. ......
For installation at: (street address) ....... --------- * ------- * ------- * --------- ----------------- ** ---------
..........
Sea Attached Sheet
Addition or Subdivision_ --- XTPA�jP�KUI.Q .. )k&ah ................ ----_-------------_- _ ................ Lot,.1,54 ....... Block.. ..............
Type of Building: New..._X ..... Existing ............ Single family residence X� ------- Number of bedrooms ------- 3- � ................
Other: (specify type or use) -------------------------------------------------- .......................... ---------- ................... .................................
Builder ------ j A ... Q,___IasB_we]_l --- Jr - - ---_----------------- ---------------- Address ..... 4-81-5-148-th --- Edmonds ..... Wash. ------------------
Designer ..... M... B. _ Me yr:* -Y
.... ... ___Uq9 ........ ............................. ----- Address ..... 2.0-019JR my .. 99 ... Lynnwaad.,_Wash . ...........
loam
Soil Log Hole No. ... 3.6."..-brownis.h..-sandy -clay/36"- -to..48.'_'...ove-r -cemented sand.-....
SoilLog Hole No. 2 ...... sarne-,as...abave ...................................... ------------------------------------------------ ___ ...........................
Elevation of Water Table, if encountered. (Distance from ground surface) --- Rane.... ........... ..................................
Corrections to control surface water if needed ......... .... n9pq ................. _ ....... ................ ........................ ................ ............
........................................................................................................................................ ................... ;�� ................ .............
Specify if any removing or grading of topsoil in field area ... No .. grading ... allowed...in.,drainf ie.1-d-.area ........
.......... PraixXield ... to ... be ... insj�-al_1ed.maxdLm=...Q* f...1a" ... i.nto..,9.x.i.st.i.ng��.g-r-o-und� ........................................
Percolation:
Test Hole No. I —Average Rate ................ 8
................................. ... .(Fall in ininutes/inch-bottom 6" test hole)
Test Hole No. 2—Average Rate ................ 8 ................................ .... .(Fall in iiiinutes/inch-bottom 6" test hole)
Test Hole No. 3 — Average Rate ............... 8 -----_---_-- ---- -------- -__ (Fall in minutes/inch-bottom 6" test hole)
Average percolation rate on which to base drain field design ....... 8 --- min., ........ ...... Date Taken ----- 7/18/63..
Septic tank requirements based on present rules and regulations:
Septic Tank Size....9PP ................. gallons.
Amount of Square Feet of Disposal Field ...... --- 45Q .......... ..... ....
Signature — Desi gner ........ Date ----- -
.............. _ ..... ------------- --------------------------- . . ....... .... .......... ------------
DO NOT WRITE BELOW THIS LINE (T66'Ke complete`�d' by ISSUing Agency)
Permit issu ed (_dag- - ------- Permit Number ----------- ------ �:/_( ... ta�
Remarks: ........... . ........ I ................................. .................................................................. _ ...... .................
........................................................... I .......................................... -------- I . .......................................... .......................... ..........
BROWN
C-uner i ptic Tank & ?JrdVbfield Dosign
J. 0. Laoswell Jr. J. C. Lasawall Jr.
4815 - 1148-th
Edmonds, "Nash. Por. Tr. 154 Ieadovidale Beach
SNO. CO. UISH.
000 gal. S.T.
ft. draintile
-ft. Trench
7.5'min to wall
Drainfield not to exceed
shaded area.
1.67,?W 7a'
Jul,i, 1963
Designert
B. Mayring
20019 Hiway 99
Lymnwcod, 'Iffash.
legal Description:
F _7'
�`ust 75-00 ft. of the
West 408-00 ft. of Tr.
OR/ 1
.154, !-:eadowdale Leach,
4sl
Except the Forth 467 ft.
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0
SNOHOMISH HEALTH DISTRICT
STREET FILE DIVISION OF SANITATION
3011 Rockefeller Avenue, Everett, Washington
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3 Copies)
Permit to be issued to: ---- J. C. Lasswell Jr.
- -------------------------------------- ......................................... .......
For installation at: (street address) ---- -7 7 � 7
---- S-A ----------
:5 e_'e_�_' e e- �F;* --------- * ---------------------------------------- * ----------
Addition or Subdivision ......... _XPM�Q IQ .. Aetaj& .................. ------- ......... ........ .-. Lot--...154 .... Block ........ __ ----
Type of Building: New .... X ..... Existing ----- _ ----- Single family residence ...... X ------- Number of bedrooms ........ 3 --------------
Other: (specify type or.use) ..................................................................... .................................. __ ...... _ ------------------------------------
... Jr.
................. -------------------_-------- Address_48 15 _148th. Edmonds.,.. Wash._ _ ..............
Designer --- Mjt --- Po --- Ke.y.rl.nz ...... .......... ------ Address-. ---- 200.19 --- Hiway. 9.9 ... Lymny;oo.d,,..Was.h .............
brownish sandy clay loam
Soil Log Hole No. 1 ------- ............................. ...... 3(�" to --- 45" ... ... cqmerxted
.................... zancir ----------------------------------------------------------------------------------- ...... ----------- -------- -------_------- ...................
SoilLog Hole No. 2___Same --- as ... a:bov-e ------------------------------------------------ ... _ _------------- -------------------------------------------------
Elevation of Water Table, if encountered. (Distance from ground surface) ---- none ---------- --_-----------------_---- --------
Corrections to control surface water if needed ....... none ...... _ ................................................................................................
Specify if any removing or grading of topsoil in field area .... No ... g.r.a.d.i.n.g ... al.l.ow.e.d ... in ... d.rainf.i.e.l.d...ar.e.a. ......
.... .. . .... .... . .. . ..
Drainfield to be installed maximum of..18" ... into existinR r.Q.qnjd., ........................
....................................... : .................... : ..................................... ....... ...... ........... I .......... ..................
Percolation:
Test Hole No. I —Average Rate ......... 8 ...................................... . .. (Fall in minUtes/inch-bottom 6" 1 test hole)
8
Test Hole No. 2 —Average Rate ......... ............................ --_--------_--- (Fall in iiiinutes/inch-bottom 6" test hole)
Test Hole No. 3 —Average Rate ......... 8 ...................... ------------- ------- (Fall in minutes/inch-bottom 6" test hole)
Average percolation rate on which to base drain field design 8 --- min..- . .............. .. Date Taken ------ 7AV63.
Septic tank requirements based on present rules and regulations:
Septic Tank Size ..... _9jQQ ............. gallons.
Amount of Square Feet of Disposal Field .... 45P .... ............ ..... ......
i /__15 Date .... --------------------- -
Signature — Designer ...... ------------------ ------------- ------------------------------
DO NOT WRITE B�k,�W THIS LINE (Vbe compVed by Issuing Agency) )
Permit issued (d:�,. -_ �. --- - --- 1_91� --- /47_AK� --- Permit Number ----- /A/ .. IL1.77 .........
Remarks:_ ........... '-.._ .......................... ............................ _ .............................. ---------------------------------- - ------- -------------_---_--
................................................................................................................... . .............. ........................... .......................... ...............
BROWN
to
J. C. Lasswall
- 1, -- -�-
4,3i5 - A�4�il
-Si-icmdr�, "AA.
�,�10 Gal. S.T.
L50 lin- ft. draim'-i1c
3 ft. Trench
I
1 .5 m1r. will to lvall
DTain"'icid --Dt tf, e7ccee6
chadod ar-,a.
93 04 To
w
Soptic Tank 6*Dra-tL,2ieIcI Deol 0
J. C. Lass-mll Jr.
Por . Tr. Ir-4 2',�admrd;-Ae R--cch
S41,110. CO.
July 1963
D�-s igm r
200,10 Yi=)- 90
L,ast 74.CO Vc- of
Wast 333'-00 !"t- of Tr.
154, Vecciordlrlo
OriDnt 1.67 ft.
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