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HomeMy WebLinkAbout7815 190th Pl Ne_BLD5022_2022 Permit Packet Coversheet Community and Economic Development City of Arlington • 18204 59th Avenue NE • Arlington, WA 98223 • Phone (360) 403-3551 Page 1 of 1 Permit Number: Permit Type: Address/Parcel: Completed (Month/Year): Land Use ˆ Notice of Decision ˆ Staff Report ˆ Application ˆ Narrative ˆ Legal Description ˆ Vicinity Map ˆ Site Plan ˆ Landscape Plan ˆ Complete Streets Checklist ˆ Traffic Impact Analysis ˆ Snohomish County Traffic Mitigation Offer ˆ WSDOT Traffic Offer Form ˆ Tree Survey ˆ Stormwater Drainage Report ˆ Geotech Report ˆ Critical Area Evaluation Form ˆ SEPA Checklist ˆ Public Notice Material ˆ Noticing and Related Documents ˆ Water / Sewer Availability Certificate ˆ Unanticipated Discovery Plan Form ˆ Aerial Photo of Site ˆ Proposed Building Materials ˆ Lighting Plans and Lighting Cut Sheets ˆ Color Elevations ˆ Design Matrix ˆ Plat Map ˆ Title Report ˆ Lot Closures ˆ Preliminary Civil Plans ˆ Archaeological Survey o Confidential Documents. Contact the City to obtain. ˆ Topography (Existing Conditions) ˆ CC&R’s ˆ Deeds / Easements / Conveyances /Dedications ˆ Developer’s Agreement ˆ Recorded Copies ˆ Bonding or Assignment of Funds o Confidential Documents. Contact the City to obtain. ˆ Letters and Project Documents ˆ Other: Civil ˆ Issued Permit ˆ Application ˆ Other Applications ˆ Construction Calculation Worksheet ˆ Approved Plans ˆ Review Comment Form ˆ Letters and Project Documents ˆ Other Agency Permits ˆ Reports: o Drainage Report Pg: o Stormwater Pg: o Geotech Pg: o All Other Reports ˆ SEPA and Noticing Materials ˆ Inspections ˆ As-Builts ˆ Other: Building ˆ Issued Permit ˆ Application ˆ Additional Applications ˆ Approved Plans ˆ Site Plan ˆ Letters and Project Documents ˆ Calculations ˆ Project Specification Manuals ˆ Reports ˆ Certificate of Occupancy ˆ Inspections ˆ Other: BLD5022 Residential Zoning Verification 7815 190th Pl Ne November 2022 ✔ ✔ ✔ Environmental Health Division 3020 Rucker Avenue, Suite 104  Everett, WA 98201-3900  fax: 425.339.5254  tel: 425.339.5250 Application For An On-Site Sewage System Permit GENERAL APPLICATION INFORMATION PROPERTY TAX ACCOUNT #: LOT #: Sec: Twp: Rg:  New  Expedited  Renewal  Redesign  Alteration  Resubmittal  Repair  Waiver Review Applicant Name: Plat / SP Name: Mailing Address: City: State: Zip: Applicant Phone: Applicant Email: Installation Address: Installation City: Water Supply: Individual Well _______ Public _______ Name __________________________________________________________ SEWAGE DISPOSAL SYSTEM DESIGN INFORMATION Type of Building:  New  Existing  SFR  Duplex  Commercial  Other __________________ # of Bedrooms_______ Pretreatment Type:  SF  ATU  PBF  N/A  Other ________________________________________________ Dispersal Type:  Gravity  LPD  SSD  Mound  SLB  Other ________________________________ Lot Size: _________________________ Operating Capacity: _______________ (gallons/day) Design Flow: _______________ (gallons/day) % Slope in Drainfield Area: __________ Depth to Water Table/Restrictive Layer: ________ (inches) Soil Texture Type (1-6): _________ Application Rate: __________ (gal/sq ft/day) Absorption Area: ______________ (sq ft) Installation Depth: ______________ (inches) Septic Tank Size: ___________ (gallons) Pump Chamber Size: _________ (gallons) Date Soils Logged: ____________________ Required Cover Soil: Volume: ___________________ (cubic yards) DESIGNER INFORMATION Designer Name (Printed): Designer Signature: Address: License Number: Email: Phone: Fee Simple Owner, Contract Purchaser or Owner’s Authorized Agent’s Name (Printed): Fee Simple Owner, Contract Purchaser or Owner’s Authorized Agent’s Signature: Designer Comments: HEALTH DISTRICT USE ONLY APPLICATION APPROVED EHS ______________________________________ Date _________________ APPROVAL EXPIRES ON: _________________ Comments/Conditions: APPLICATION DISAPPROVED EHS __________________________________________________ Date__________________________________________ Rev102119rso 04/12/202404/12/2022 SNOHOMISH HEALTH DISTRICT Please Note: This Document May Not Reflect Accurate Scale As Shown. 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