19720 86TH PL W.PDFIIIIIIIIIIII
8210
19720 86TH PL W
SNOHOMISH HEALTH DIST
RICT
DIVISION OF SANITATION
3011 Rockefeller Avenue, Everett, Washington
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3 Copies)
Permit to be issued . ......... e�;:2zz'*ZeA)l .... .................... .........................
..... . .... ..
For installation at: (street address) ----------------- . ...............................................................
j
Addition or Subdivision --- .......... --------------------------------- Lot ..... �? ----- Block .............
Type of Building: New .... Existing,.4k ... Single family residence._,X"-. ---- Number of. bedrooms ..... 3� ................
Other: (specify type or use) ----------------------------------------------------------------------------- ........ ................................................. ................
Builder 117V'Address__e?:?
--- . .....
V�Designer.. j/;,_2Z .................. Address-, /'?Z� ------- 4 .. .......
Soil Log Hole No. ......
I
71 ................................................................................... ............... ............... ........ .............................................
SoilLog Hole No. 2 ..... ...... ...... Y_ ------_---- _ ..................................................................................
...................................................................................................... ........... ........ ................ ....... ................................... ...........
Elevation of Water Table, if encountered. (Distance from ground surface) .................... ........... ..............
Corrections to control surface water if needed_
........... ............................................................... 7 .......................................................... .............. ...................................................
'/ ...... �7 ...............
Specify if any removing or grading of topsoil in field area..,A ------ f_ r'Wiell.2,
Percolation:
Test Hole No. I —Average Rate ... ------------------- _ ..... _(Fall in minutes/inch-bottom 6" test hole)
Test Hole No. 2 —Average Rate ... ................. ___ ------------ (Fall in minutes/inch-bottom 6" test hole)
Test Hole No. 3 —Average Rate --- f'W..1 _ a Z 2� �-r ---------------- (Fall in minutes/inch-bottom 6" test hole)
Average percolation rate on which to base drain field design ....... ------------- ...........
Septic tank requirements based on present rules and regulations:
Septic Tank Size._4�� ----------- gallons.
Amount of Square Feet of Disposal Field .... :__�17 ---_-__-----------
Signature — Designer_756_01/1�7 --- ................ .. Date__//Z:-1/,-_-.-.3
/ Z_
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit issued (date) ............... 12- L 3 'q -------------
....... .. .................. Permit Number_ ......... �1.IaAu
Remarks: ..............................
PROWN
The� y of
,37
APPLICATION CARD No . ......................................
6c7REff='r FILE for
Edmond SIDE SEVMR PERMT
EASEMENT No. .................................
OUTSIDE [1] INSIDE E] REPAIRS E]
6:51
z / /:)
OWNER ---------------- ........
................... CONTRACTOR
...... ---------- /Ze
7 ---------------------------------------------------
* ------------- PERMIT No.
/ /0 7
t�& ry'(1'
STREET
HOUSE No . ............ ....... ..................................................
. . . ..... ............
........... AVENUE LOT
No. .............................................................
BLOCK No . ...............................................
NAMEADD.
-------------------- -------------- ------------------- ----- ---------------------------------------------
------------------------ ----------------
Date
BACKPILL WORK ORDER ISSUED ................................... DEPOSIT, $ .........................................
SEWER WORK ORDER ISSUED ..........................................
/V
Approved:
DATE — ........ ff: .. ----------------------------- i -------------------
I I .............................. By .........
NOTICE:
U �1. �d k�,:
-N:O,*,w-ar-ra'nt'y--OT.a.lc.(.�, Y_
The information'shown on the attached
map(s) was compiled for use by the City Of
Edmonds/ its Employees and Consultants,
The City of *Edm.onds does not. warrant the
accuracy of anything set forth on t ' hese
Map(�-). Any person or entity -requesting a
copy should conduct an independent
0 -ation shown on
inquiry regarding the inf* rm I -te.d to,
-t-He -map(s)/ including, but not I mi -h
th'e location of any sew-er stub shown. Suc
sewer stubs may or may- not exist and may
or may not exist at the location sh ' own.
r"ity of Edmonds nor its
Neither the %.. i -c e -r s 's h. a -'I b e Vi a. b-'Fe f o r t h e
emp., ee-s o-r off" 1*
1'0'Y
information given' on this Map(s), nor for
'ded based
any one representation provi
upon said map(s).
CITY OF EDMONDS
Can PRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT is ready for Inspection. (No Inspec-
tions Saturday, Sunday or holidays.) N2 1338
SIDE SEWER PERMIT
19720 - 86th Place West
ADDRESS------ -------------------- _ ........................................................................................................................................................................
Manuel L. Favorite CONTRACTOR ............... R.oy...Allen ............................. ..........
OWNER ........... ........................... I ...................................................... .. ..... ....... .....
Perndssion is granted ........... 19-55-., for ...................... days, to REPAIRLor CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before It has been inspected.
NOTE No. 2—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 Inches inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE No. 4—Trenches in street must he water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5—It Is unlawful to alter or do any other work than is provided for In the permit, or to do any work on the main sewer or Its ap-
purtenances except to insert the pipe Into the wye.