1985, 07-09 Permit App: 00006347 Pool BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name e.-R-44-Kr-41-
` erti(first) (m) meet Use Only Comm
2 Pfoject Address(not Mailings Address)cr Road Name Space qv Zip
3 City/Community State Su Ivision/Plat tatt - T`LF-R Pr. /3 Cf'p
4 Assessor Parcel No. Lot Block
* * * DEPARTMENT USE ONLY * *
5 Sic Code Zone Act.# Zone A 6S V.tom Project No.
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
7 Set Back-Front 1(L)S-1 (R)S-2 Rear Census Tract I Module No. Initials
GA td
* 16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
dritl tractor Firm Name wStreeAddress
-- aai` '� Pet.,_ 11 (/ 00+ Pisa
1 City State Phone
L, 'Po E_ b044 so9) 9 v7rs-2-7 ?
Contlact n KrS
License T 1 74- 1 b 1 _aPhon(if 'ferent than above
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone
( )
12 Review Required Plan Check(Y/N) Other(Y/N) SEPA Exempt(Y/N) Date
�i )5 Type W ❑ Bldg ❑ MH New ❑ Replace Other S'WiN1
�y[b LJ) ► i— ❑ Fire ❑ Demo ❑ Add/Alter ❑ Move IC x3Z RteL
14 Describe Work
10 piicant Name Street Address
11 Zip City State Phone
( )
*
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
•
DEPARTMENT APPROVALS
This is not a Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
❑ Fast Track
❑ Early Start Release
Release w/cond 1 Hold 2
❑ Environmental Health ❑ Commercial; ❑ Residential
W.1101 College ❑ Construction; ❑ Bldg alteration/addition
Room 200 g/Additional structure;
APPLICATION# 1-918'
Conditions/Comments:
❑ Planning/Zoning: ❑ Commercial; 0 Cert.of Exemption; 0 Frontage;
N.721 Jefferson ❑ Setbacks; 0 lot w/d; 0 lot size; ❑ use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
❑ Engineers: 0 Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson ❑ drainage 0 new access/approach; 0 fence;
❑ road improvements
Conditions/Comments:
•
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
❑ Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
a
(1)
C
�
Project Representative Telephone
0. Agencies Performing Special Inspection:
o 1•
• '—
• i0
F E
2.
o
LL
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3.
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
'SPOKANE COUNTY HEALTH DEPARTMEN
Division of Sanitation _ ---. . . — _ V - -
1127 W. Mallon Avenue d 4,0 - p
Spokane I I, Washington lr O. O
• DATE....._-...1i.'"-...L._d NerC)
APPLICATION FR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
(;)
_____Addy@ss .. _-..._....----{ Phone No Ci..)et, g Go 9
Address Proposed iyef) Sy'._...._._._._.......-..._...-_......_.�._....__..---.__._._..._._._.__...__.-:Size of Property._._-71rr..,l.t'i.7
Typeof Use .....:..._._._... . ._._._.-•-•-- -...-_... ...._ _.. __..Other.._.__.-•---._._._._._.-._...._....----.._..._.._._.__.._..._..-_-_._-_._.......--- __._...._
Number of Bedrooms...._3___._Building Capacity _._._..__...-__...__Camp Capacity _..._....___...._.._ Other..-_ __....__.__.____.__..___
Is property below grade of streets or alleys?. ._..___.._..._....__._._.Are streets graded in?Is basement for building planned...__ _...- -.. .__....__.-_...._. ...._-..-_..How much excavation or fill proposed'....:_.
yy, �
Water Supply..---/_ `---,.__.t ._.------- ty, Well, Spring).
Septic tank capacity._..__ O o-----_- gals. Style of tank._._---•--------__._..._ .... ..
Length of .disposal field..._/1- -... 444.41.10„....;‘
_ _-`
(1) Draw in property area to scale. ( /
O Lr5�.
(2) Show relative location of: Proposed house, septic tank,
disposal field, well, garage, and other out buildings. ��_
Ti._ t 5" r'
(3) Make note of any heavy slope or swampy area or any ' 441
other important topographic details. Ct
. ibr ^/ 0 • 1.)
Date when test hole will be ready for • �2(.r v/
inspection .
Date installation will be ready for final inspection (that is, 0 '�/p_�7 I
before baokfilling). ....._..___._._._._._._____._..__._....__-_....-•---...._...-----•-•-•-- T ts` .14
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__.___.._._.__..__._.___.-----•--•-•--------._...___.__...._._._...._....__..-------••---_._._.-•-------------.. ice..-s
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ARLO-
SANITARIAN'S REPORT AND RECOMMENDATIONS: �� k
Cfil
Date of spectio�..__._._..-_..._.__....__.___.
Topography s
GroundWater __...__._�._ ----_---•----___.__..._.____.-•-•-- ••----_---_-•--____.._ ____._.-•--_--..._.
Soil Condition .._------_.Percolation tests: Minutes_____________
Special Recommendations _._.__ r _ ----._._ _.-.,......__..__.__-___-._._.__..-._._._..._.._._._.____..._.____.__
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Final Inspection Date ` .0 / • . , • ... 1
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SEPTIC TANKS ARE DESIRABLE IN ALL INSTANCES, CESSPOOLS ARE NOT SANITARY. i••
' r ;h Y SANITATION IS VITAL TO GOOD HEALTH Y., 4-
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s'C1;1LENV•glif t e ti kation Response
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