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1993, 04-16 Permit App: 92004384 ResidencePROJECT NUMBER= 92004384 APPLICATION DATE= 04/16/93 PAGE= 01 ****** THIS IS NOT A PERMIT ****** PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT SITE STREET= 524 N BELL ST ADDRESS= GREENACRES WA 99016 PERMIT USE= RESIDENCE - NATURAL GAS PLAT#= 003447 PLAT NAME= BLOCK= 2 LOT= AREA= 00000000 F/A= # OF BLDGS= 1 # DWELLINGS= OWNER= DESERT WEST MINERALS STREET= 17927 E APPLEWAY AVE ADDRESS= GREENACRES WA 99016 PARCEL#= 55183.1302 ERRET'S ADD 2 ZONE= UR -3.5 DIST#= G F WIDTH= 85 DEPTH= 135 R/W= 50 1 WATER DIST = CONSOLIDATED IRRG #1 CONTACT NAME= D HUFFMAN BUILDING SETBACKS: FRONT= 30 LEFT= 10 PHONE= 509 924 9202 PHONE NUMBER= 509 922 6397 RIGHT= 10 REAR= 78 ****************************** REVIEW INFORMATION ***************************** DEPARTMENT REVIEW REQUIREMENT BUILDING PLAN REVIEW REQUIRED APPROVAL: K MYRE ENGINEER APPROACH/FLOOD PLAIN/DRAINAGE APPROVAL: S LIGHTFOOT HEALTHDIST NEW OR ADDITIONAL WASTE WATER COMMENTS: DATE: 06/22/92 ******************************* BUILDING PERMIT ******************************* CONTRACTOR= C W BUILDERS INC STREET= 17927 E APPLEWAY AVE ADDRESS= GREENACRES WA 99016 NEW= X DWELL UNITS= BLDG W X D = REQ PARKING= REMODEL= 1 OCCUP. LD= 26 X 44 SQ FT= #HANDICAP= DESCRIPTION GROUP TYPE BASEMENT U R-3 VN DECK R-3 VN GARAGE M-1 VN RESIDENCE R-3 VN PHONE= 509 922 1260 ADDITION= CHANGE OF USE= BLDG HGT= 16 STORIES= 1 1163 SPRINKLER= N CRITICAL MAT= N SQ FT 455 80 400 650 VALUATION 5005.00 400.00 3200.00 35100.00 PROJECT NUMBER= 92004384 APPLICATION DATE= 04/16/93 2ND FLOOR R-3 VN 513 13851.00 ITEM DESCRIPTION QUANTITY FEE AMOUNT RESIDENTIAL VALUATION Y 450.50, STATE SURCHARGE Y 4.50 RESIDENTIAL SURCHARGE Y 81.09 RADON MONITOR 1 19.43 SALES TAX 1 1.55 PAGE= 02 ******************************* MECHANICAL PERMIT **************** * * CONTRACTOR= UNKNOWN STREET= UNKNOWN ADDRESS= UNKNOWN WA UNKNOWN ITEM DESCRIPTION PHONE= QUANTITY FEE AMOUNT GAS WATER HEATER 1 10.00 GAS HTG EQUIP<100,000>BTU 1 12.00 GAS PIPING 2 2.00 VENTILATING FANS 3 30.00 ***************************** PLUMBING PERMIT *****************************: CONTRACTOR= GOLD SEAL MECHANICAL INC STREET= 5524 E BOONE AVE ADDRESS= SPOKANE WA 99212 ITEM DESCRIPTION PHONE= 509 535 5944 QUANTITY FEE AMOUNT TOILETS 2 12.00 SINKS 2 12.00 BATH TUBS 2 12.00 KITCHEN SINKS 1 6.00 DISH WASHERS 1 6.00 GARBAGE DISPOSAL 1 6.00 CLOTHES WASHER 1 6.00 FLOOR DRAINS 1 6.00 SEWAGE EJECTOR 1 6.00 PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING BUILDING PERMIT 557.07 .00 557.07 MECHANICAL PRMT 54.00 .00 54.00 PLUMBING PERMIT 72.00 .00 72.00 683.07 PROCESSED BY: FORRY, JEFF PRINTED BY: BARRY HUSFLOEN .00 683.07 ******************************** THANK YOU ************************************ O - d 41 SPOKANE COUNTY DEPARTMENT OF BUILDINGS -W. 1303 BROADWAY'AVEN6UE e SPOKANE, WASHINGTON 99260 (509) 456-3675 I certify that I have examined this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE provisions included herein and agree to comply with same All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not l understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to give authority to violate or cancel the provisions of any state or local law regulating construction, or as a warranty of conformance with the provisions of any state or local laws regulating construction. SIGNATURE OF APPLICATION OWNER OR AGENT DATE \Vi Lk cA0- PROJECT NUMBER:-: 920043014 APPLICATION DATE== } 1.6/92 iPAGE 01 **3.3*3*3* THIS IS NOT A PERMIT 3*3*3*3*3*3* PENALTIES WI:L..L.. BE ASSESSED FOR COMMENCING; WORK WITHOUT A PERMIT :SITE STREET= 524 N BELL Sr ADDRESS= GREF.NACRE,S WA 99016 PgRMTT' USE= RESIDENCE -- NATURAL GAS PLATO= 003447 PLAT NAME=: BLOCK= '2 LOT= AREA= 00000000 1=/1:3= T OF HI 0L - 1 0 DWELLINGS= OWNER= DESERT WEST MINERALS STREET= 17927 E: APF'I...E:'WAY AVE: - 'ADDRESS= GRI:::ENACRE.S WA 9901 A CONTACT NAME= 13 HUFFMAIN • BUILDING.SETBACKS: FRONT= 30 PARCEL..:;::.: 55183.1302 ERRET' S ADD _2 ZONE= UR -3.5 DIET1 = F WIDTH= 85 DEPTH= 1 35 R/W= 50 i WATER DIST = C:ON,SOI..IDATED IRE(' 01 PHONE... 509 924 9202 PHONE NUMBER= 509 922 6397 LEFT= 10 RIGHI= 10 REi.iRn. 79 x*3*3*3***3*3*3';3*3*3*ii•.M.Lt.ri:.li.:n:itiEirdia:-yi•****** Fi:F.:.:r1.1.W 1NE ORMAI.I.ON s':•3t•4f*}eti3(3i*3S• 7EX*it•ksiid3FYiiift•.ri•.n..*** DEPARTMENT BUILDING ENGINEER HE::A1..THD1.ST REVIEW COMMENTS FLAN REVIEW REQUIRED APPROACH/FLOOD PLAIN/DRAINAGE NEW OR ADDITIONAL WASTE WATER 3*3*H3f•4**.3*3*3*3*3*7i*ir.****3E34 N.*3t#*3i1i H-3*ie3t. CONTRACTOR= STREET= ADDRESS= NEW= DWELL. UNITS= BLDG; h1 X D REL? PARKING= 3*3 3*3Fw.N...i.*3*3*3f 3*3*3*3* 3*3* 3* 3*3*3*3*• CONTRACTOR:::. SrI EEr ADDRESS= 313*3*3*3*3*3t•3*3*3** *3*R3*3*3* CONTRACTOR= STREET. ADDRESS= PROCESSED BY: FORRY, ._TEFF PRINTED BY: FCIRRY, JEFF BUILDING REMODEL= OGCUP . LD - SQ FT= OHAN01( AI'-'::_ APPRO4'a• L COMMENT PERMIT-X...3*3*1*3*3*..h..A.ii.}:3i3i3r3i3}3{3f .)e.i(3k ,ri..****3t •3*a.3*3*3* MECHAM is CAI. PHONE - ADDITION= B1...DG HGT SPRINKLER= CRITICAL MAT= :PERMIT 3*3*3*3*3*3*3*3**. PHONE= CHANGE' OF USE= STORIES= *3t. i 3*343*i4 PL..UHBING PERMIT ie**3t•3i••3*3*3t3e3*3*•*.,....3t•.h•.** *** *3*N.•3***3' * *3*M•3*i*3*ii•3*3t•3*3*3*.1t•3t•3*3*•3*•3*3i•3*3*3*3*•3*3*3*3eri•i*•3*••iii* 1 THANK YOU PHONE= 3* 3t• 3*.li.3t• 3* 3,: .3* 3* 3t• •1*• ii• k• 3t• 3* # 3t. }* 3t:HYi• i* it 34 x 0 0 0 0 - e NOTICE It is the responsibility of the permittee, not Spokane County, to see to it that the use described on the front of this permit complies with applicable codes and requirements and that required inspections are requested. Failure to request required inspections and obtain the necessary approvals prior to progressing beyond the point where inspections are required may necessitate removal of certain parts of the construction at the owner's/permittee's expense. At a minimum, the following inspections ARE REQUIRED by County Code: 1. FOOTING — when forms and reinforcement are in place and prior to placement of concrete. NOTE: This inspection includes review of the structure's setbacks from property lines. Minimum setbacks are established by County zoning regulations. Typically, side and rear yard setbacks are measured from property lines, while setbacks for yards abutting streets are measured from the property line or the center line of the roadway right-of-way, whichever provides the greater setback from the center line of the roadway right-of-way Curb lines and fence lines are not necessarily indicative of property lines. In some residential areas, the County can own as much as 20 feet of right-of-way between your property and The actual improved street/curb. The responsibility to comply with applicable setback provisions lies solely with the permittee — neither Spokane County nor its authorized representatives assume any responsibility for the verification or location of your property lines. Please verify their location prior to locating your stricture. Failure to properly locate the structure may require its relocation at the owner's/permittee's expense. 2. FOUNDATION— when forms and reinforcement are in place and prior to placement of concrete. (Blocking fora manufactured home is required to be inspected prior to the installation of skirting.) 3. FRAMING — after all framing, bracing and blocking is in place, and prior to concealing. 4. INSULATION — prior to the installation of drywall. 5 PLUMBING — after rough -in, before covering, and final. 6. MECHANICAL — rough -in of piping, before covering, metal chimneys before concealment, and final. 7. FINAL — when complete and prior to occupancy and/or use. Please provide 24 hours notice. NOTE: In addition to inspection of thestructure, this inspection includes review of site improvements (typically depicted on the approved site plan) required by ordinance or as a condition of approval of this permit Items such as the installation of fire hydrants, fire department access, on-site drainage ("208 swales"), road improvements, parking, and landscaping are common requirements of a permit/site plan which must be completed priorto final approval of a building or assurance of a Certificate of Occupancy. In addition to the above any plumbing or mechanical systems or materials which would be concealed by framing, drywall, concrete, etc., must be inspected prior to cover. Check with the department for "special inspections" in conjunction with commercial projects. CALL 456-3675 FOR INSPECTIONS. TO INSURE PROMPT SERVICE, PLEASE GIVE 24 HOUR NOTICE. YOUR INSPECTOR IS UNDER CERTAIN CIRCUMSTANCES, PARTS OF YOUR PROJECT MAY REQUIRE INSPECTIONS FROM OTHER AGENCIES: o road cuts for utilities or drives, State or County Engineer's Office 456-3600 o on-site waste disposal system, Environmental Health District 456-6040 o construction in a flood plain, County Engineer's Office 456-3600 o electrical wiring, State Department of Labor and Industries 456-2792 o sewer connection, County or City Utilities Department 456-3604 EXPIRATION ;d,er se noted, this permit will be considered null and void by limitation of the work authorized by the permit is not nennced or is stopped for a period of 180 days, unless a written request for an extension of the permit is received and wed by the Building Official prior to expiration. At a minimum an inspection should be requested at least once every 180 to assure the validity of the permit. A permit may be renewed within one year of the date of expiration for one-half the al fee, subject to certain limitations — please call us if you have any questions. - MISTAKES? inroihink we've made an error in processing this permit or in conducting inspections pertaining to it, or find erroneous oays\tion in the permit, please bring it to our attention immediately by filing a written request for correction within 10 working per m. discovery. All such requests should be directed to the Department of Buildings at the address found on the face of this spokane County - DEPARTMENT OF BUILDING & SAFETY West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 PARCEL NUMBER: INFORMATION WORKSHEET STREET ADDRESS: 7 )Z_4 ,L- ST CITY/STATE/ZIP: S 0Q K-_ 4 E LA.J A • SUBDIVISION: R_ ETTS W) t 0 Ni BLOCK: LOT: ZONE: DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: 1 # OF DWELLINGS: OWNER: 1 ^oNSc, WATER DISTRICT:Cc.�IIT19 . ' esel“ t,sUI SSC M 1 LA--cS PHONE : MAILING ADDRESS: el 1 Q4-7 ArloPuG 1AJ A - ` �n CITY/STATE/ZIP: te- A.CAt'-gy\"-Iik G . Sl -1.02„ CONTACT: 40-•b" PHONE: 5 - 9 SETBACKS: - FRONT: 7..S LEFT: IC) RIGHT :1 -1- REAR: PERMIT USE: **** **************** *******************+ *********** ********************* BUILDING INFORMATION CONTRACTOR LICENSE NUMBER:49/ \,�% �a Sb� PHONE: Jv 9 _91y__ q L 0 Z - CONTRACTOR: C v �..� Y \\\N_ MAILING ADDRESS: C \1 %-7 eto L, ok y C--yz.A. ARCHITECT/ENGINEER: PHONE: MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: 11/Z__ BUILDING DIMENSIONS: Z to X vy (WIDTH X DEPTH) SQ." FT.: , REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL: Please provide the following information for Energy Code compliance: Space heating type (check one) Forced air electric Electric baseboard or wall mount Propane ✓ Forced air gas Heat pump Other: Flat ceilings R C) Doors U Vaulted ceilings R 8 Windows U os n Above grade walls R i q Glazing+aiea "'- # 1 ? 2 . °°I/O:9 i_ j Below grade watts R 1 9 Total floor area Floor R 30 of heated space '; 1. Co 18 Slab on grade R F Furnace efficiency rating ti Please indicate on your plans: The location of the radon vent, and the location of the vent fan area. Square footage �� Main door: J-` ) Second floor: 1. • - Basement - Finished: Garage: Carport: Decks: 801‘ Unfinished: ZOO Additional Areas: j f LENDER/BOND HOLDER: p u.{i — N / ( =D111) ADDRESS: CONTACT: PNONE: 1 PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: PARCEL NUMBER: OWNER: ---1),``7t-NJ[Wt-g-7- M�=� I�J�PHONESNUMBER: SD Q 9 15/ 9 za9016 i MAILING ADDRESS: L= (7 "I -7 A -PPL c uJ c z€ lliscA �i q 7 Ci 1 i7 (Street) ( ity/State) �(Zip) CONTRACTOR: CL t I -LO -S LICENSE NUMBER: CW �Co1 .0050b� PHONE NUMBER:��l�L MAI LING ADDRESS: L`l72L7 �PPtEal 6(Ll VLrS 9Q0tt (Street) ( ity/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS SINKS SHOWERS BATH TUBS'.' KITCHEN SINKS DISH WASHERS, GARBAGE DISPOSAL CLOTHES'.WASHER UTILITY SINKS ELECTRIC: WATER HEATERS FLOOR DRAINS FLOOR SINKS' . T: BAR SINKS ROOF DRAINS LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE SEWAGE,EJECTOR WATER SOFTENER URINAL. DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 NUMBER OF UNITS X EACH UNIT = AMOUNT 2 x 6.00 = x6.00 = x 6.00 = x6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 = 2- 2— I 1 1 1 1 ( SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 MECHANICAL PERMIT APPLICATION FORM • • Information Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: PARCEL NUMBER: OWNER: -De4eY<.T L9 )-.5-1" M I N aK.KL,S PHONE NUMBER: &t� �9., nria V MAILING ADDRESS: C 11 0417 .swoOLea)4-/ C/(��-IVAt'''3 (Street) 11 (City/State) CONTRACTOR: C UJ ...._:1,.)1 L. i en -S LICENSE NUMBER: C(SF3u _ PHONE NUMBER: MAILING ADDRESS: t (7 qt7 Qr"pce \ /1-t1 Oa,u - /4ca r\ (Street) ! (City/State) MECHANICAL WORKSHEET/FEE SCHEDULE DESCRIPTION ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) WOODSTQVE /INSERT. ` :?? GAS WATER HEATER GAS EQUIPMENT <100,000 BTU(INCLUDES GAS EQUIPMENT+100,000 BTU DUCTWORK) GAS PIPING (EA OUTLET)..,:'_[; :. : , BOILER/REFRIG 1-100M BTU BOILER/REFRIG'101=500M BTU: :.: BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG 1',0001-1',750M' BTU..::: ::..::....:::: BOILER/REFRIG +1,750M BTU HEAT PUMP & AIRCONDITIONER:04 TONS.::.::, HEAT PUMP & AIR CONDITIONER 3-15 TONS H EAT PUMP & AIR CONDITIONER 15-30,TONS: HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP & AIR' CONDITIONER +60,TONS:.., VENTILATING FANS EVAPORATIVE COOLERS TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD .. CLOTHES DRYER RANGE GAS LOG MISCELLANEOUS. (NOT. COVERED ELSEWHERE:::: UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED:.GASAPPLIANCE>400,000 9TU.;.....;. USED APPLIANCE <400,000 BTU USED: APPLIANCE>400;000 BTU`::.::::: AIR HANDLER <10,000 CFM AIR HANDLER 5,19,000 CFM.::`::,;: NOTE: MINIMUM PER T FE _ IS, •35.00 SIGNATURE G 401,6 (Zip) p£3Qb t3 Old (Zip) NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = I I Z I i _ sei_ SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE _ $ Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 02/09/94 14:55 $509 324 1567 SP CT—Y HEALTH • ^APPLICATION4AND PERMI•T5TOR ON+ SIrTE 1=`SEWAGE••+ SYSTEM ANE COUWfY HEAITH DISTRICT61/142,100 ENVIRONMENTAL HEALTH DIVISION WEST 1101 COLLEGE AVENUE • Y SPOKANE, WASHINGTON.99291-2095 009)456-6040 SITE ADDRESS OR LEGAL DESCR ION OF PROPERTY: PROPERTY MIN: LEGAL sad A rwi 2s APPLTCATION NO. CENSUS TRACT _ ill, DATE OF APPLICATION [ jool 1` PSSA (4. WINSTOE ASA) IT LSSA (OUT/INSIDE ASA) �] WWMA (OUTSIDE PSSA.ASA,GSSA) [] OUTSIDE ALL OF ABOVE [1 INSIDE ASA ONLY CLOP NCHEiT [] SPLIT ENTRY MULTI-LEVEL [] MULT1-FAMILY COMPLEX: NO. UNITS N0. BEDROOMS/UNIT L] COMMERCIAL/TNDUSTRIAL {DESCRIBE): #EMPLOYEES(OAY: #SCATS/CHAIRS FOR CLIENTS/CUSSTOMERS: IS THIS PROPERTY LOCATED WITHIN A COMMUNITY PUBLIC SEWER SERVICE AREA? [] YES () NO TF.TES NAME OF DISTRICT/SYSTEM: IS OLID AJREEMFNT COMPONENTS_ ER OF P'OPERT/ (] RA PROP SED USE OF PROPERTY: ODRESS: 1 LF -FAMILY RE IDEM L � - NUOFlit DR TYPO OF STRUCTURE: O MOBILE HOME P UP05E0 SYSTEM BY APPLICANT: SEPTIC TANK(5) NO. l _ SIZE L OTHER PRETREATMENT FACILITY (SPECIfY) 'URAINFIELD [] LEACHBEU [1 BONDING SEWER f] OTHER U15POSAL FACILITY (SPECIFY) WHAT IS THE SOURCE Or WATER FOR SEWAGE SYSTEM /e O° REiUIRED? YES N0 REPLACEMENT/FAILURE: ()YES XNO ALTERATION; ()YES REASON: O SATURATION/BUG O RELOCATE - CONFLICT [] OTHER [1 CHANGE OF USE [] ADD-ON WILL THIS RESULT IN AN INCREASED SEWAGE FLOW? (1YES talk THIS PROPERTY: PUBI.iC/SHAREU WATER SYSTEM: NAME PRIVATE_: f 1 WELL f1 SPRING, 1 1 _AKE [ 1 OTHER: PROPOSED PLOT PIAN 15 TO ACCOMPANY THIS APPLICATION, ALONG WITH ANY OTHER PERTINENT INFORMATION, SUCH AS LE DESCRIPTION OF PROPERTY. THIS APPLICATION AND PERMIT APPROVAL 15 CONTINGENT UPON MEETING REQUIREMENTS SLT FORTH IN THE SPOKANE COUNTY NEALT DISTRICT RULES AND REGULATIONS FOk ON-SITE SEWAGE SYSTEMS_ APPROVAL IS BASED ON THE ACCURACY OF THE INFORMATIO SUPPLIED BY THE APPLICANT_ If YOU ARE DISSATISFIED WITH THE DECISION OF THE NEALIH DISTRTCT, YOU HAY APPEAL TO TH HEALTH OFFICER WITHIN TEN 4 DAYS OF DENIAL OF THIS APPLICATION (SEE APPEAL PROCEDURE). CONTACT "-:.ON: SIGNATUR OF OWNER OR AUTHORIj 0 R PRESENIA IVE: MAIL PERHi A CORR PONDENCE 70: TEST IDLE 1NSP, PARTIAL INSP. INSPECTION CA L - FINAL IRSP. INSPECTION PHONE: FEE PAYMENTS: APPLICATION PERMIT REINSPECTION DATE: RENEWAL `t'SCHEDULE'' *t OF- 1<1AFPROVALS4 H,I;TICAI. MAIERIAt USER !. []YTS VINO 1-WAGE;MALNTENAHCE4ODEEMENT•REOUIRED? []YES, ,AQ1D.. SA/SCND DENSITY REDOIREHEItTS °.f LYES WHO ER: AGE CY {i.e . 1.5n, P.LetJ , .DOE) APPROVAL b UAT.E TEST, .PRO kl_ AcV SEG: GATE 1±61.1141t _ RFA Doi FACILITY: :`� SEPTIC TANK SIZE::•• l`GREASL TRAP SIZE , j) , -,PUMP CHAMBER:SIZE., 100 -FOOT SETtACK RE uIRED1 "(ZYES_. NCI EASEMENT SQUIRED? OYES 5N0 3/Ci1ffiIQ N6y�lAlE 'Tpjis•t T Tf..• . '''.':GAL/DAY DISPOSAL FACILITY .:.• -... ;:• '• :: .p4 ORAINI-LELD:: S12.E FLOW RATE [SOIL„ LOADiNS3.4RATEC .- Q Q i} GALS. NO, ?� GALS /fT2.x b ," TRENCH W1OtH] %=:) 5 LINEAL FT; GALS. N0, :. [] .LEACHBEO: ,.FLOTil• RAT£ : SOil••LGAOING;;RGTE.,, GALS, N0. GALS./FT?'. S0 'FT... [:]".SAND FILTER 8E0: -LOW `RATE : 1.2 GALS - FTS (] ALTERNATIVL [1.HDUND [),PRESSURE DIST SED ='}:OTHER: P OTHER (SPFC1 Y) . EE AETERNATej " c_ '1 EN SPECS. ATTAcHED -... TE: TER E.M. PROGRAM APPROVAL AND DATE: /� OUBLE PLUMBING REQUESTED - DA d{-1 REQUIRED f( RECOMMENDED f/A f1 SE POT ;LA (] 2. 8 REQUIREMENTS RC)110 OLID TO APPL. DATE: �J SEF PLOT PLAN OLIO ROVE] GATE; INSTALLER: (PHONE NUMBER) (INSTALLER SIG ATURE) M�1RK51 AN�D�4PP�LhoO'NUI (}Nb. (+.A T c k: o c, SCHD-EMU-0532 (REVISED 3!881 FUTURE SEWER SERVICE FORM: 0"__ L. J? k •