19811 82ND PL W.PDF111111111111
7651
19811 82ND PL W
0
APPLICATION
The City of Edman for EASEMENT NO - ---------- ---------------------------------
STRE" FILE SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS E] LID NO - ------------------ - ASMT. NO - ------------------
OWNEP- ------------------------ ............................. -------- ----------------------- -------- CONTRACTOR ------------ _ ------------- ......... ----------------------------- ---------- PERMIT NO. ------------------
JOB ADDRESS J-9M - ----- ---------------- LEGAL DESCRIPTION: LOT NO - --------------- ----------- ------ ... BLOCK NO - --------------------------------
NAMEOF ADDITION ---------------------------------------------------------------------------------------------
Approved:
DATE----------- -------- ----------------------- By --
-19'ICT
SNOP01 WSLif
DIVISION OF SANITATION
3011 Rockefeller Avenue, Everett! Washington
APPLICATION FOR A SEWAGE DISPOSAL PERMIT
(Submit 3 Copies)
Permit to be issued
--------------------------------------- --------- ------------------------ --------- ------------ ....... . ------ ..........................
For installation at: (street address). ...... AJ .................................. .....................................
Addition or Subdivision ... Th;OM(A�J --- 0_0 h ---------------------------- ------------ ......................... . Lot --- /N ----- .. Block:_ ............
Type of Building: New-.-74 Existing ............ Single family residence-!-< ... Number of bedrooms ... :3� --- -----------
Other: (specify type or use) ................. --------- ............... ---- - --------- --------------------- --_------- --------------
0
Builder ----
-------------- -
Designer --- ThcMaS --- Go' ... White ------------- ...... ....................... Address. ---I ................. ....
Soil Log Hole No. .......
KA r -
---------------- ----------------_---------- - - ---------------------------------- ................ ..................... ...... ........ ................................
SoilLog Hole No. 2 .... -'-..0 . ............................... ; ......... ........................... .......................................... ..........
............... .................................................................... k ................... --------- a .................. -------------------------------- ............. ..........
Elevation of Water Table, if encountered. (Distanc6:frbni gi�oufid ............. ............ ........ .....
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 ---- ....... .......... (Fall in ininutes/inch-bottom 6". test hole)
Test Hole No. 2 —Average Rate ............ 47 ---_-------------------------
Test Hole No. 3 —Average Rate .... ____'5 ----------------- -----------
Average percolation rate on which to base drain field design
Septic tank requirements based on present rules and regulations:
Septic Tank Size ... 900F�:��_ ....... gallons.
..... (Fall in minutes/inch-bottom 6" test hole)
...(Fall in minutes/inch-bottom 6" test hole)
------------ -------- Date Taken- 461�12'-63�
Amount of Square Feet of Disposal Field. ... ......
Signature — Designer7.5� ... �_- _4`�5 ----- 4/4" -- --------------------------------------------- Date.�_Augquat..2i.,.1963 - --------
DO NOT WRITE BELOW THJ� LI To be completed by ISSUing Agency)
Permit issued (date) ................ Permit Number ............. -- ----------- . . .....
-----------------------
Remarks:_ .......................... I ...............
................................ .......... I .......... ........................ __ ------------ ................
------------------------------------------------------------------------------------------------------------------- ................................................ I ................................
BROWN
,49-r
4�
REGARDING:
19811 - 82nd Place West
--I
o,9-ee7z_�oo
(address)
R E C 0 R
D 0 F C 0 N T A
C T S
DATE
NAME, PHONE NO., &
COMMENTS
ADDRESS of CALLER
5/l/74
Annette Vaughn
Certified
Letter No. 406266
sent
requiring
hook-up within 60
days.
6/74
D.T.O.S (No'record put into
file.)
6/24/74
Certified
Letter No. 406500
sent
rescinding
previous letter.
1/5/76
ACTION TAKEN
Letter received.
Letter received.
Recorded in as -built files.
INITIALS
TE
TE
TE
JT
-SENDER: Reiurc to folloty onsfr*ucfion on fher idii
7_i V
EA SE FURNISH SERViCE(S) -jN I DICA, -CHUR
TED BY
'(Addit I idniii, 4�es.req,uired_ for, these miviaesl)
7
D W 6'NLY-
how,addreiss"7, e iver
L--J Wt1er6.j"e1iVe_nM',
i to addre'ssee
L.A
RECEIPT
numbL�red.aificle,desi:ribdd,Letow,
fli ;�E_Gj�TE9 D'NO
NATURE OR NAMEOF ADORES�!� - t "I'! "s, be filled 1h)
—W W
CER RK
CERTIFIED, NO--- IFIT FOR 0,
-------- I -
D E
TMED MAIL
1, L
RECE
4 0,6?
SIGNATURE OF,ADORESSEE'S AGENL/My,
2 309-09200
-MURED NO _t h. lf:9
ANNETTE
VAUGHN,
cc
j9811 82ND PLA
t::, PATE: DECIVE ED1. S HO.W,WHERE -DELIVERED' _(PiZ0 if rcdtkest'lid,,d-:zd�i7fcludc ZIP Co i de) NOS, WASHIINGTON
EDMO
98020
%
00ITIDNAE FEES
.... .. --opTIONAL SERVICES FOR A 150
'iEN ERft"sij id d te delivered
D, e�_ rL- lo� follo w in�fru tfion on- .9 fh e r si e Shurls to whorn an a . .. .... 650
ddressee only
with delivery to 35d
Shovis to vihom, daite and here delivered
RETURN
PL ASE: F6 PT 2. essee only .. .. ... .. 850
RNISHSERVICE BY- -CHECKED. BLOQn(s) RECEIP With delivery to addr
504
�',(4ddit 6�al_�hai��es, services) SERVICES V .....
............. .. ... .. .
R T ADD ESSEE ONLY . ........... ......
r--j Sh9w,addre`s'Ts cienver ONLY. jDE u ........... : ........... .. .. ...... (See other side)
SP L
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L-j- whiere del kie 6�' lo, addr6s ale— SP VERAGE PRO
DELIVERY (extrcl �ee eq ire VIDEO_
NO INSURANC Gpo: 1970 0-397,45S
PS Fo
RED 3 NOT FOR
_11�,:�,:_ E I PT- 00 INTERNATIONAL MAIL
R ived4hie hui�bered kfiiEW'dei rib�ie�d 6" 1 Apr.
ce a C �e Gwr
1E,GISTERED NO . NATURE OR NAME OF"�p SEE -(Mu alwayi be had in)
CERTIFIED NO.
IGNATURE70F ADDRESSEE'S AWT. I F A
y
;�WSWEQ NO. -
'&ATUDENVERE WHERE'DELIVERED '(Only if—r�Tq—uisted,ai.�diiiclud6�ZIPCod�)
-P SHOW
'j, is postage)
_30� (PIV
3
MARK
IFIED MAIL
ERI
'-.ECEIPIr FOR C1 TE
-------------
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SENT
NO.
ST�EET AND
W-
P.D., . STATE AND ZIP. C.ODE
U—) q, S
f0jlAopjTjotIAL F E 15
and d3t deliver
opyl to vilhoin 650
ressee 0 5d
a resse 3
CD F, ShOVIWS ith delivery to n a
are
0
REIUhV4 Sih.�s to -hom, date 0 1 ......... ... 850
RECEIPT �Iiv�ry to. resse
With de . . ......... . : ... sod
,SERI%lICES
m AD REsSEE.ONLY ..... ..........
1DELIVER TO uired) ...... .... (Sea other sicle)
SPECIAL DELIVERY (extr" "" req c EME ORoVIDE13 .,.! .1. 0-397--58
140 INS RANCE C ATIO AL MAIL
pS form 800 NOT FOR INT
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