1997, 03-19 Permit App: 97001505 Change of UsePROJECT NUMBER= 97001505
PROJECT NUMBER= 97001505
APPLICATION- DATE= 03/19/97
APPLICATION DATE= 03/19/97
PAGE= 01
PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 1418 S LIMERICK DR PARCEL#= 45243.0519
ADDRESS= VERADALE WA 99037
PERMIT USE= CHANGE OF USE - RESIDENCE TO ADULT FAMILY CARE
PLAT#=
BLOCK=
AREA=
# OF BLDGS=
002316
5
00000000
PLAT NAME= ROTCHFORD ACRE TRACTS
LOT= 19 ZONE= SR -1 DIST#= F
F/A= F WIDTH= 150 DEPTH= 300 R/W= 60
DWELLINGS= 1 WATER DIST =
OWNER= SIMMONS, LESLEY L
STREET= 1418 S LIMERICK DR
ADDRESS= VERADALE WA 99037
CONTACT NAME= BILL DALEY
BUILDING SETBACKS: FRONT= NA
PHONE= 509 922 7870
PHONE NUMBER= 509 328 0193
LEFT= NA RIGHT= NA REAR= NA
******************************* BUILDING PERMIT *******************************
CONTRACTOR= OWNER
NEW=
DWELL UNITS=
BLDG W X D =
REQ PARKING=
REMODEL=
OCCUP. LD=
X SQ FT=
#HANDICAP=
DESCRIPTION GROUP TYPE
ADULT CARE LC VN
ITEM DESCRIPTION
PHONE=
ADDITION= CHANGE OF USE= X
BLDG HGT= STORIES=
SPRINKLER= N
CRITICAL MAT= N
SQ FT VALUATION
.00
QUANTITY FEE AMOUNT
CHANGE OF USE/SAFETY INSP Y
STATE SURCHARGE Y
PERMIT TYPE FEE AMOUNT
BUILDING PERMIT 54.50
54.50
PROCESSED BY: JULIE SHATTO
PRINTED BY: JULIE SHATTO
50.00
4.50
AMOUNT PAID AMOUNT OWING
.00 54.50
.00 54.50
******************************** THANK YOU ************************************
APPLICATION
Spokane County Health District
Environmental Health Division
1101 gest College Avenue
:._ \AIA on�n,_�no� rano► ��d_
FOR ON-SITE SEWAGE SYSTEM
Application No..y-, ..;)1,;,
Area Tract:4
Date of Application:02/21/;j.
ally Inspection Announcement 324-1681 Inspection Cagan: 324-1560
v t....r ...— - -— —
JFJys•OI wJ • • •-•v v ....• . ..v v .•. — —
Subdivision/Block/Lot: Property Size:
L19 R5 ROTCHF ) VALLEY` I.n`_3 1.3 ACRES
Site Address or Legal Description of Property: Town/City: Parcel 1:
o L4(" ',n_Vc F�\ �,1 . c.-,0374524, 0519
f�i. i� `...ail:_i �. (.7. NIVE, � tY 11FM_f_ art •��J
Legal Owner of Property: Address: 141E SOJTH LIhERIC1:: DRIVE Daytime Phone:
'4 r I I. It'Ar, NI EY YEE=C6ALE, WA 99037-0000
Property Use:
3.31r1G1 drhi.te Desi t? Ei: IE1,'(C;,q- ot51
New system: d # - ,, 1 r, _tc, _
What is proposed: i .i do /1 ar�lc No. Size:
Property is located within: cSSfi
Instdr 433
OGrease Trap No.--77—Size 1 „
OHolding Tank No. Size:
OOther - Specify:
Replacement for failure/saturation:
Exposure -no record of system/other:"'
Other:
CLUP:
U=Urbai S=Suburban Z=lncorp.
R=Rural SR =Semi -Rural A=Agricultural
C=Commercial I=Industrial X=Other
Will this proposal result in INCREASED sewage flow?
Alteration - relocate/conflict:
Alteration - change of use:
Alteration - add-on: ie
Is this property within a community public sewer service area?
If yes. name of district/system: ;cJ
v_
Is Real Property Covenant required?
Ni.-,
FSSA Form 0640E: ONAOfaxed-Date: Rcvd Date:
RPC Form given to applicant - date:
Form received - date:`
Final:
4
Source of water:
Ex:i�ting -i:ciicisiared 4ater Klui e - 7'13:c/IA VERA
2°29 DC€5.'!00T, App 1 Y
THIS IS NOT A PERMIT Page 1 is an application; page 2 is a permtit if ngn.d ropriately.
A proposed plot plan is to accompany this application.»along with an other �.< acr ption of property. 'This
application and permit approval Is contingent upon meeting requirements as POKAtE COU h; LES AND REGULATIONS'yFO N
SITE SEWAGE SYSTEMS. Approval is based on the accuracy of the i formatio ti � y hi'appkcant ;you are dfied with the decision of:
APP Y ��� � � MO -APPEAL
the Health District, you may APPEAL to the Health Officer within TE 10) DA Y$ f► nisei o this appticatio i' OCEDURE).
Contact: Phone: Mail Correspondence to:
WILLIAM D `(,LEY or Phone: (5O9) 3 -C1�' 1418 S1JTH LIMERICK DRIVE
Signature of Authorized Representative: VERADALE WA 99037
ATTACHED PLOT PLAN DESIGNED BY: / , l(
WILLAM'Aa
phone:
Inspection Call -In Dates
Fee Payments
Testholes:
emt.paid
date
reg.:
�
check/
�
paid by:
� I
Partial:
Application:
-
� '
/ �
Final:
Permit:
mei
'
Reinspection:
2929 Review:
NM--_
Exposure:
Reinspection:
"
=MIMI
—__
.
Other:
AIt.Sys. Insp..
Plan Review:
_--
Renewal:
REMARKS:
12/94
FOLLOWUP DATE: 01/21/98
Page 1- Application
LEGAL OWNER: WILLIAM DALEY
ADDING A SYSTEM
CONTACT NAME: WILLIAM DALEY (509)328-0193
PERMIT APPROVALS
Site Address or Legal Description of Property: S 1418 LIMERICK DRIVE
Parcel #:15243.0519 Subdivision/Block/Lot:
{..19 05 ROTCI FORD VAf EEY ACRES
Appl. #: 97-00105
Critical Material User: , ■ Yes ■ No
CM Apreement,Received-d te:
Segregation Date:
100 -foot setback required: ❑Yes
Easement required: ❑ s o
Easement re eij'•Cao:
Sewage Maintenance Agree 91 fired: /Yes ONo
OASAOSCHD:Densi �R i ants: OYes ❑No
' Method I 0 ltinth6 2 0
• Area of Special Concern: Yes ❑No ID#:
p c
0
Other Agency Approval/
Planning, DOH) Ra� .: (i.e., Engineers, Utilities,
TESTHOLE APPR • • t. Si ATURE AN ► D • TE:
,
N MUM .SPECI . CATIONS REQUIRED
Flow rated gal./day dosage vol. gal/cycle
MINIMUM BPECIFICATI •rS REQUIRED
DISPOSAL FACILITY:
O Drainfield Size:- Flow Rate /(Soil loading rate
i,
gals./ft X � inches width)
TREATMENT FACILITY:
Septic Tank Size: /L0 42) C5 gals. No.
lin.feet ■ Cap Fill
❑Grease Trap Size gals. No.
[ Leach d: Flow rate /
rate , � gain./ft.' = %I
of ding
q.ft.
❑Pump Chamber Size: gals. No.
❑Sand Filter Bed: Flow Rate / 1.2 gals. = ft.'
OHoiding Tank: gals. No.
Alternative: • Mound ■ Pressure Dist.SSAS
'Sand Filter ■ Other:
See Alternative System Specs. Attached.
❑Building Sewer ■ Dist.Box
DOther:
• • • MUST F LLOW APPROVED PLOT PLAN ***
Other EH Program Approval and Date: NA
❑FOOD ■ WATER-,REC:
Application Approval Sign re: 4= ate:
7 M !''� Z Z,/ 17
D.
1�rt!AL
Approved Aiiiiiretion Expires
.,•w ;,
❑SCHOOL■ ATER -
4'
❑OTHER: . , ,,-�, , . ,
Double Plumbing Requested -Date:
Building Department Release Date: Initials:
❑Required ❑Recommended SIA ❑ ee plot plan
Installer/Designee:
Installer Company:
Permit Issued Date:a/Zi97Expires:a4'/Ylnitials: tt—
Multiple Unit Permit Expires: DNA
Installer Signature:
FinatInspC� g a a ��- � :Date: ,
'D'^K:� Y . . , u • . _ �.. .
TOTE:
THIS IS A PERMIT ONLY WHEN THE APPROPRIATE SIGNATURE IS ENTERED
UNDER 'APPLICATION APPROVAL SIGNATURE' AND 'PERMIT ISSUED' DATE IS
COMPLETE.
REMARKS:
Page 2 - Permit