HomeMy WebLinkAbout7630 190th Pl Ne_BLD4335_2025 7630 190th Pl. NE, Arlington, WA 98223
Permit Department - Town & County A Division of Permabilt
16521 Highway 99, Suite C Lynnwood WA 98037
425-743-1555 permit_assist@permabilt.com
42' x 40' pole building, no heat or plumbing
✔
42' 40' 22 1935
92782.8 32473.98
4735 92782.8 0.051
03316
✔ ✔
56298
36564
0
53566
82488
56469
08694
28385
43350
70724
31528
25739
25
12/23/2021
CONSTRUCTION CLEARANCE
REQUEST FOR A HEALTH DISTRICT CONSTRUCTION CLEARANCE AND/OR WATER SUPPLY COMMENT
PROPERTY TAX ACCOUNT NUMBER:
FOR PDS USE ONLY
SITE ADDRESS: PDS PLAN CHECK #:
SITE CITY: SEC 63/GMA Compliance Required? YES________ NO________
SP # / Plat Name: PDS NAME: Expedited Review _______
Sec: Twp: Rg: Site Legal Description and Lot #:
OWNERS NAME: PHONE:
OWNERS EMAIL:
MAIL ADDRESS: CITY: STATE: ZIP:
CONTACT PERSON: PHONE:
CONTACT PERSON EMAIL:
MAIL ADDRESS: CITY: STATE: ZIP:
IS SEPTIC SYSTEM / DRAINFIELD: INSTALLED/EXISTING* PROPOSED NOT APPLICABLE
*If installed/existing, approximate year of installation ______________________
Has a new onsite sewage disposal system application been made to the Snohomish Health District in conjunction with this proposed
building project? __________ YES __________ NO
INDICATE SOURCE OF WATER: INDIVIDUAL WATER SUPPLY PUBLIC WATER SYSTEM NOT APPLICABLE
Has an individual water supply application been made to the Snohomish Health District in conjunction with this building project?
__________ YES __________ NO
Explain building project and its use (SFR, addition, shed, etc.): _____________________________________________________
Is plumbing for any structures: EXISTING PROPOSED BOTH EXISTING & PROPOSED
Indicate total number of bedrooms before and after construction: BEFORE:_________ / AFTER:___________
MINIMUM PLOT PLAN REQUIREMENTS TO BE SUBMITTED WITH THIS APPLICATION DEPICTING THE FOLLOWING:
1. Scaled Drawing (max. 1†= 100’) 5. Location of Existing/Proposed Water Well.
2. Dimensions of Property Lines. 6. Location of Existing/Proposed Water Lines.
3. Dimensions of Existing and Proposed Structures and 7. Location of Septic System Components:
their distances from Lot Lines. - Septic Tank and Primary Drainfield
4. Roads, Easements, Driveways, Parking and Pavement - Pump Tank, ATU, Sand Filter, etc. (if applicable)
Areas. 8. Location of Septic System 100% Reserve Area.
SIGNATURE OF APPLICANT: ________________________________________ DATE: __________________________
FOR HEALTH DISTRICT USE ONLY
WATER SUPPLY INFORMATION: (If Required By Building Department)
Appears to be consistent with recommendations contained in "Guidelines for Determining Water Availability for New Buildings",
issued April, 1993 as per Section 63 of Growth Management Act (GMA).
Does not appear to be consistent with recommendations contained in "Guidelines for Determining Water Availability for New
Buildings", issued April, 1993 as per Section 63 Growth Management Act (see attached sheet for deficiencies).
ONSITE SEWAGE DISPOSAL SYSTEM:
APPROVED DISAPPROVED BY:_______________________________ See Letter Dated __________
Initial and Date
CONDITIONAL APPROVAL: Conditions To Be Typed On Building Permit
DO NOT FINAL STRUCTURE WITHOUT PRIOR SNOHOMISH HEALTH DISTRICT FINAL APPROVAL
OTHER _____________________________________________________________________________________
_____________________________________________________________________________________
BUILDING CLEARANCE APPROVED: BASED UPON REVIEW OF THE ONSITE SEWAGE DISPOSAL SYSTEM
INFORMATION AND, WHEN APPLICABLE, THE WATER SUPPLY INFORMATION.
REVIEWING SANITARIAN: DATE: ____________________
Environmental Health Division Rev021020rso
3020 Rucker Avenue, Suite 104 ï® Everett, WA 98201-3900 ï® fax: 425.339.5254 ï® tel: 425.339.5250
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