1997, 04-09 Permit: 97002080 MHSPOKANE COUNTY DIVISION OF BUILDING AND PLANNING
1026 W. BROADWAY • SPOKANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION
SITE ADDRESS: 1218 S SIESTA DR
SPOKANE WA 99206
PARCEL NUMBER: 45203.1001
SUBDIVISION: SIESTA MOBILE PARK 1ST ADD
LOT: 1 BLOCK: 10 ZONE: UR -3.5
INSPECTOR: FRANK PALADICHUK
WATER DIST:
OWNER: HLUBOKY, JOHN
PHONE: 509 891 6014
ADDRESS: 1218 S SIESTA DR
SPOKANE WA 99206
MOBILEHOME PERMIT
CONTRACTOR
OWNER
LICENSE #:
INSPECTION FEE
STATE SURCHARGE
COUNTY SURCHARGE
TOTAL PERMIT FEE
1
4.50
11.00
$65.50
PAYMENT SUMMARY
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
04/09/97 00002679 $65.50
TOTAL FEES AMOUNT PAID AMOUNT OWING
$65.50
$65.50 $.00
ISSUED PERMIT BY: JEFF FORRY
PROJECT INFORMATION
PROJECT NUMBER: 97002080 ISSUE DATE: 04/09/97
PERMIT USE: EXISTING SINGLE WIDE MANUFACTURED HOME
APPLICANT: HLUBOKY, JOHN
PHONE: 509 891 6014
ADDRESS: 1218 S SIESTA DR
SPOKANE WA 99206
CONTACT: JOHN MLUBOKY PHONE: 509 891 6014
SETBACKS -> FRONT: 30 LEFT: NA RIGHT: 10 REAR: 20
LENDER NAME:
PHONE:
ADDRESS:
NOTES
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 structure. 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 for a 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 the structure, 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 prior to final approval of a building or issuance 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:
• Road cuts for utilities or drives, Division of Engeering & Roads
456-3600
or State Department of Transportation
456-3000
• On-site waste disposal system, Spokane Regional Health District
324-1560
• Construction in a flood plain, Division of Engineering & Roads
456-3600
• Sewer connection, County Division of Utilities
456-3604
or City Public Works Department
625-6300
• Electrical wiring, State Department of Labor and Industries
324-2640
EXPIRATION
Unless otherwise noted, this permit will be considered null and void by limitation of the work authorized by the permit if not commenced or is stopped
for a period of 180 days, unless a written request for an extension of the permit is received and approved by the Building Official prior to expiration.
At a minimum an inspection should be requested at least once every 180 days to assure the validity of the permit. A permit may be renewed within
one year of the date of expiration for one-half the original fee, subject to certain limitations— please call us if you have any questions.
MISTAKES?
If you think we've made an error in processing this permit or in conducting inspections pertaining to it, or find erroneous information in the permit, please
bring it to our attention immediately by filing a written request for correction within 10 working days of discovery. All such requests should be directed to
the Division of Building and Planning at the address found on the face of this permit.
CI 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 w' mpli with whether specifi-d herein or not. I understand that the issuance of this permit/application and any
subsequent inspection pprovals C icates of Occ ..n. .hall not be construed to give authority to violate or cancel the provisions of any
state or local law reg ating cons ruc or as a w. .rtty •f/conformance with the provisions of any state or local laws regulating construction.
SIGNATURE OF
OWNER OR AGENT
APPLICATION
DATE
y S�
APPLICATION AND PERMIT FOR ON-SITE SEWAGE SYSTEM C/ /�
APPLICATION NO. % 7 _! ,
CENSUS TRACT
DATE OF APPLICATION
SPOKANE COUNTY HEALTH DISTRICT
ENVIRONMENTAL HEALTH DIVISION
WEST 1101 COLLEGE AVENUE
SPOKANE. WASH Ni, GTON 99201-2095 (509) 32a-1660 INSPECTION
SIT!/Ab ESS OR LEGAL DESC'IPT10N �F PROPERTY:
ri2'J
LEG AIrU INER
RECORDING: 326-1581
PROPERTY WITHIN {1PSSA WIT /INSIDE ASA)
C S ,t / [] GSSA (OUl/INSIDE ASA)
e'e jlA Y.".47`� PHONE: 7F, (] �SIDEA UALLDOFE PABOVESA,GSSA)
L fG / [] INSIDE ASA ONLY ET
PROP .D USE OF PROPERTY: STN �i-FAMILY RESIOENCf� -.NUMBER OF BEOROOMS
TYP OF S1RUCIURE: OBILE HOME
(] MULTI -FAMILY COMPLEX: N0. UNI1S
J1 COMMERCIAL/INDUSTRIAL (DESCRIBE): $EMPLOYEES%DAY:
IS THIS PROPERTY LOCAIED WITHIN A COMMUNITY
IF YES . NAME OF DISTRICT/SYSTEM:
(3 RANCHER EI SPL11 ENTRY [] MULTI-LEVEL
N0. BEDROOMS/UN/1
JSEATS/CHAIRS FOR CLIENTS CUSTO RS:
PUBLIC SEWER SERVICE AREA? [j YES [] NO ,�,%J/`��
IS JLTO AGREEMENT RE'UIR ,�/�
SEWAGE SYSTEM COMPONENTS: r
�RQPOSED SYSTEM BY APPLICANT: REPLACEMENT/FAILURE: YES []NO AITERAT ON: [YES 0
SEPTIC TANK(S) N0. SIZE R N: [] RELOCATE - CORFU T
(1 OTHER PRETREATMENT FACILITY SATURATION/SDG [] CHANGE OF USE
(SPECIFY) [] OTHER [] ADO -ON
(] DRAINFIELO XLEACHBEO
[] BUILDING SEWER [] OTHER DISPOSAL; SPECIFY:
WILL THIS RESULT IN AN INCREASED SEWAGE FLS 2 []YES []NO
NA - NEW SYSTEM
WHAT 1S THE SOURCE Of WATER FOR THIS PROPERTY: PUBLIC/SHARED WATER SYSTEM; NAME:
PRIVATE: ftWELL fl SPRING f] L- E [] 2929 APPLIES (] 2929 DOES NOT APPLY
PROPOSED P101 PLAN IS TO ACCOMPANY 1H1S APPL[CA116N, ALONG IIH ANY OTHER WHINER INFORMATION, SUCH A5 GAL UESCRIPIION Of
PROPERTY.
IHIS APPLICATION AND PERMIT APPROVAL I5 CONTINGENT UPON MEETING REQUIREMENTS SET FORTH IN 1HE SPOKANE COUNTY HEALTH DISTRRICT
RULES AND REGULATIONS FOR ON-SITE SEWAGE SYSTEMS. APPROVAL IS BASED ON INE ACCURACY OF 1HE INFORMATION SUPPLIED BY 1HE
APPLICANT. IF YOU ARE DISSATISFIED WITH THE DECISION OF 1HE HEALTH DISTRICT, YOU MAY APPEAL TO THE HEALTH OFFICER WITHIN TEN
110 DAYS DENIAL OF THIS APPLICA ION SEE APPEAL PROCEDURE OUTLINED IN THE REGULATIONS).
CONfir 'RSON: ): SIGNATURE OF OWNER OR AUTHORIZED REPRESENTATIVE:
//i i
MAIL PER1
CO .` ESPONO NCF�,1
FEE PAYMENTS: AMT. PAID DATE -EG., , PAID BY
APPLICATION Y�
PERMIT �.'nT>Z%7-i/'
REINSPECTION
PLAN REVIEW
RENEWAL
2929 REVIEW
LE OF APPROVALS
•
SEWAGE MAINTENANCE AGREEMENT REQUIRED? ()YES SEG. DATE: 100 -FOOT SETBACK REQUIRED?
fITES f
ASAISCHO DENSITY REQUIREMENTS:f1YES fINO(Lfe (/ r�'t1 /1�- EASEMENT REQUIRED? f1YES f
OTHER A ENCY .e., Uti11ties,Plannin ,00 APPRbVAL/DATE TEST
9 ) E APTVAL SIGNATURE ANO DATE.
FLOW RATE_ 6AL/DAY DOSAGE VOL. GAL/CYCLE DISPOSAL FACILITY:
[3 DRAINFIELD SIZE! FLOW RATE :(SOIL LOADING RATE
/F12 x " TRENCH WID1H] = L1I(JAL FT.
EACMBED: FLOW RATE : SOIL LOADING RATE % C,
GALS./FT2 a Law SQ. FT.
(]ALTERNATIVE: []MOUND []PRESS.OIST.SSAS []SANG FILTER
[]011;ER (SPECIFY):
SEE ALTERNATIVE SYSTEM SPECS. ATTACHED
rLL O MINIMUM SYSTEM SPECIE ATfONS BY DISTR[CT
TRE 1 FACILITY:
( SEPTIC TANK SIZE: 4K'JI - AMALS. N0.
(] GREASE TRAP SIZE: //GALS. NO.
(] PUMP CHAMBER SIZE: GALS. NO.
(] SAND FILTER BED: FLOW RATE : 1.2 GALS = FTL
[] HOLDING TANK: GALS. NO.
fl BUILDING SEWER .[]OTHER:
OTHERAE Pj10GRAM
r/
APPROVAL AND DAIS: AP!yCATION APPRO L SIGN RE AND
DOUBLE UMBING REQUESTED
f1REOUIREO f1 RECOMMENDED
08 REQUIREMENTS RCV'0
1.
•
1N
E:
►. N/A ] SEE PLOT P A
ULT' TO APPL. 0A1E:
ID RCV'D DATE:
A SEE PLOT PLAN UL
LLER' (PHONE NUMBER)
REM R S ANO APPR
(INSTALLER SIGNATOR )
L CONDITIONS: (see reverse side also)
BUILDING DE RELEASE
PER
155
ED
AAPNAL INSPECTIO
Ii
SIGMA
RE
-1
i
ANO
---i•NdTIALS:
RES: 1N1
TE:
SCNO-0D-0532P(REVISED 5/92)
T0'd
FUTURE SEWER SERVICE AREA FORM:
•
or
APV
FOI,LOWUP DALE:
VT:2T ,66T-60-ZIdti
INSPECTION CALL-IN DATES
TEST HOLE INSP.
PARTIAL INSP.
FINAL INSP. f.
/ I
`-'liar
- i a _-_
,% -.S_.
REINSPECTIO
EXPOSURE
�.,,,..... ...
---
--
SCHEDL
FEE PAYMENTS: AMT. PAID DATE -EG., , PAID BY
APPLICATION Y�
PERMIT �.'nT>Z%7-i/'
REINSPECTION
PLAN REVIEW
RENEWAL
2929 REVIEW
LE OF APPROVALS
•
SEWAGE MAINTENANCE AGREEMENT REQUIRED? ()YES SEG. DATE: 100 -FOOT SETBACK REQUIRED?
fITES f
ASAISCHO DENSITY REQUIREMENTS:f1YES fINO(Lfe (/ r�'t1 /1�- EASEMENT REQUIRED? f1YES f
OTHER A ENCY .e., Uti11ties,Plannin ,00 APPRbVAL/DATE TEST
9 ) E APTVAL SIGNATURE ANO DATE.
FLOW RATE_ 6AL/DAY DOSAGE VOL. GAL/CYCLE DISPOSAL FACILITY:
[3 DRAINFIELD SIZE! FLOW RATE :(SOIL LOADING RATE
/F12 x " TRENCH WID1H] = L1I(JAL FT.
EACMBED: FLOW RATE : SOIL LOADING RATE % C,
GALS./FT2 a Law SQ. FT.
(]ALTERNATIVE: []MOUND []PRESS.OIST.SSAS []SANG FILTER
[]011;ER (SPECIFY):
SEE ALTERNATIVE SYSTEM SPECS. ATTACHED
rLL O MINIMUM SYSTEM SPECIE ATfONS BY DISTR[CT
TRE 1 FACILITY:
( SEPTIC TANK SIZE: 4K'JI - AMALS. N0.
(] GREASE TRAP SIZE: //GALS. NO.
(] PUMP CHAMBER SIZE: GALS. NO.
(] SAND FILTER BED: FLOW RATE : 1.2 GALS = FTL
[] HOLDING TANK: GALS. NO.
fl BUILDING SEWER .[]OTHER:
OTHERAE Pj10GRAM
r/
APPROVAL AND DAIS: AP!yCATION APPRO L SIGN RE AND
DOUBLE UMBING REQUESTED
f1REOUIREO f1 RECOMMENDED
08 REQUIREMENTS RCV'0
1.
•
1N
E:
►. N/A ] SEE PLOT P A
ULT' TO APPL. 0A1E:
ID RCV'D DATE:
A SEE PLOT PLAN UL
LLER' (PHONE NUMBER)
REM R S ANO APPR
(INSTALLER SIGNATOR )
L CONDITIONS: (see reverse side also)
BUILDING DE RELEASE
PER
155
ED
AAPNAL INSPECTIO
Ii
SIGMA
RE
-1
i
ANO
---i•NdTIALS:
RES: 1N1
TE:
SCNO-0D-0532P(REVISED 5/92)
T0'd
FUTURE SEWER SERVICE AREA FORM:
•
or
APV
FOI,LOWUP DALE:
VT:2T ,66T-60-ZIdti
AFR-0 -15.97 13.: 15
FINAL AJ -SULCI LNIALLAi1Um
11 �' 01,,1
►Lol i'
c\
0'
THE sYsrLOCATION� �On!-SrrE yAGF
Nt
ttOrrO API
EXACT CONSTRUED
REMARKS (continued):
PT r
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F.02
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TOTAL P.02