1996, 10-10 Permit App 96008901 MHPROJECT NUMBER= 96008901
APPLICATION DATE= 10/10/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 17623 E INDIANA AVE
ADDRESS= GREENACRES WA 99016
PARCEL#= 55073.0820
PERMIT USE= NEW DOUBLE WIDE MANUFACTURED HOME
PLAT#=
BLOCK=
AREA=
# OF BLDGS=
OWNER=
STREET=
ADDRESS=
002044
00000000
1 #
PLAT NAME= PLAT"A" GREENACRES IRR.DISTRIC
LOT= ZONE= SR-1 DIST#= G
F/A= A WIDTH= 198 DEPTH= 640 R/W= 40
DWELLINGS= 1 WATER DIST =
STUKEL, TOM OR FE
17623 E INDIANA AVE
GREENACRES WA 99016
CONTACT NAME= TOM OR FE STUKEL
BUILDING SETBACKS: FRONT= 111 LEFT= 68
PHONE= 509 624 2802
PHONE NUMBER= 509 624 2802
RIGHT= 70 REAR= 100+
****************************** REVIEW INFORMATION *****************************
DEPARTMENT
REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REQUIRED
COMMENTS:
ENGINEER
COMMENTS:
HEALTHDIST
COMMENTS:
oK peg A<<Ac-He�
APPROACH/ DRAINAGE/ FLOOD
ia-is-940f trA8voI
NEW OR ADDITIONAL WASTE WATER
X/A( AVA- e-
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER
YR/MAKE= 96/MARLETTE
SERIAL#=
ITEM DESCRIPTION
PHONE=
MODEL=
WIDTH= 26 LENGTH= 60 HEIGHT= 10
INSPECTION FEE
STATE SURCHARGE
COUNTY SURCHARGE
PERMIT TYPE FEE AMOUNT
QUANTITY FEE AMOUNT
2
Y
Y
100.00
4.50
22.00
AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 96008901 APPLICATION DATE= 10/10/96 PAGE= 02
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 126.50 .00 126.50
126.50
PROCESSED BY: BURRIS, ROBIN
PRINTED BY: BURRIS, ROBIN
.00 126.50
******************************** THANK YOU ************************************
slope) and drainage
undaries
i buildings
ainage, etc.)
(existing and proposed)
s closer than 100 feet to your
septic system and 100% CNQ
of all items
CONSIDER:
be located with easy access for
ntaining the drainfield.
shall be at least:
-ty lines and easements
ings and water lines
source of water which includes
ids, streams.
at least two laterals or runs of
Ian 100 feet of drainfield pipe per
pe shall be installed level, or drop
• 100 feet. Ends must be
e under area where vehicles pass
Id at least 4 feet from the septic
sinfield trench or Leachbed.
ripe must be at least 4 inches lower
;ading out of the septic tank.
least 5 feet from any structure or
wn system, please pick up a copy
RULES AND REGULATIONS FOR
1EMS.
/roc
l/an
r �
I \I
DIRECTIONS TO SITE: —
1
c
/
1 i-
1~�
v
LJ
North
/t-
ck I i fled roc.1 /10:6- // d o .
tired' /7ky,G�
“ I cei,L y�ny
d a /).g fee.
/ C 0-4.5 74- 71"G oZ f /pCa5/ /✓;/T'?
7 . 4ci;c241d Sf, J 7u.12 e 727 QLnd
yo LIe s 71- /7714 c ,2 4 f7
2. If not, what take place? C�land use action has or will es
ADDRESS: � 1^I c- Z I N l
ZONE
ROAD WIDTH. 0
np� FRONT
COMMENT
REV EWEU B
LW APPL.#:
ADDRESS: i 7 a 23 ���/a.7a 5. -
h. �S% / 9r7 i
` €r C7 ac�r� - /
.,.......y .4c.,.ul
Drainfield
Leachbed
Trench width
feet
sq.feet
inches
Maximum trench depth
Minimum trench depth
Cap fill
Five gallons of water are required
for "D" Box inspection
Extra gravel required under the
perforated pipe:
Oyes Ono
Call (509) 324-1560 for
Inspection before covering.
If you cannot install this
system according to this
approved plan, you must call
the office at (509) 324-1560
to discuss BEFORE THE
INSTALLATION.
Signature
i -\l A -
Date
r.Rn•SS SECTION
E.
Ono
i •'7 (- Cc % c /J/;)7`'/ '- 'c < /' C.' c/Lc / o.,
I• Is the property s• ize the same as shown on the assessors map or plat map?/yes f n�r�° `� /
✓� n.r
- e PERMIT APPROVALS
i1te Address or Legal Description of Property: E 17623 INDIA%
Parcel #: 55073. 0870 Subdivision/Block/Lot:1 n
Appl.#: 95-OO 61
Critical Material User: ❑Yes ,t9No
CM Agreement Received -date:
Segregation Date:
100-foot setback required: ❑Yes tiNo
Easement required: ■Yes XINo
Easement received - date:
Sewage Maintenance Agreement Required; •Yes ONo
i DASA,OSCHD Density Requirements: itlYes DNo
Method I 0 Method 2 0
Area of Special Concern: •Yes ONo !DV.-
Other Agency Approval/Date: (i.e., Engineers, Utilities,
Planning, DOH)
TESTHOLE APPROVAL SIGNATURE AND DATE:
MINIMUM SPECIFICATIONS REQUIRED
Flow rate: 3kgal./day dosage vol. gal/cycle
MINIMUM SPECIFICATIONS REQUIRED
/ DISPOSAL FACILITY:
ei-- Drainfield Size:- Flow Rate /(Soil loading rate
7).0 gals./ft' X Ao inches trench width) =
TREATMENT FACILITY:
1,OSeptic Tank Size: MOO gals. No.
2O(.) Iin.feet' ■ Cap Fill
❑Grease Trap Size gals. No.
D Leachbed: Flow rate / Soil loading
rate gals./ft.' = sq.ft.
❑Pump Chamber Size: gals. No.
❑Sand Filter Bed: Flow Rate / 1.2 gals. = ft.2
❑Holding Tank: gals. No.
Alternative: ❑Mound OPressure Dista.SSAS,'-
❑Sand Filter ❑Other:
See Alternative System Specs. Attached.
❑Building Sewer ODist.Box
❑Other:
• ° • MUST FOLLOW APPROVED PLOT PLAN ***
Other EH Program Approval and Date: DNA
❑FOOD :WATER AEC:
Application_Approval Signature:/ . ` , / ter
% ; ; .- ' r( t. /GfiL. / / '
Approved Application Expires:
❑SCHOOL •WATER:
❑OTHER:
Double Plumbing Requested -Date: ,'34.66
Building -Department Release Date: Initials:
f ,'1-'/',/9c e ``y
❑Required ❑Recommended 'DNA ❑See plot plan
Installer/Designee:
Installer Company:
Permit Issued Date: "> ,-- Expires: °/'�•/' 1 Initials: `' (--
Multiple Unit Permit Expires: ONA
Installer Signature:
Final Inspection Signature: Date:
NOTE:
THIS IS A PERMIT ONLY WHEN THE APPROPRIATE SIGNATURE IS ENTERED
UNDER "APPLICATION APPROVAL SIGNATURE" AND "PERMI ISSUED" DATE IS
COMPLETE. PERMIT
REMARKS:
3E
4
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