HomeMy WebLinkAboutSEP1974-00282Include the following items on your plot plan:
❑ Property boundaries
❑ Names of adjacent streets
❑ Driveways and parking spaces
❑ Surface water (ponds,creeks, etc)
❑ Buildings(residence, sheds, garages, etc)
❑ wells
❑ Septic tank
❑ DraMeld (enter NN if unknown))
❑ North Arrow (�
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Permitsr Parcel4 '-")Za
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, 903 E. ;Caroline OLYMPIC HEALTH DISTRICT Permit NO. st.
Port A* tiles SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Puplicate Builder
Court House
Port Townsend Date
WNEB .e,�,,,, .-, ADDRESS T, i 13r /3cg Alf' PHONE -7 15S / 9'7S
DIRECTIONS FOR LOCATING SITE
APPLICATION IS H'MEBY MADE TO: INSTALL ND -4 S TEM. REPAIR EXISTING SY 'i'E�I
YPE OF BUILDING
IN 0. OF KZROOMS
I BASaiENT I SITE SIZ
NAME OF INSTALLER
irraie.-- ltr�-ur_�. u�- Na f�Z'fFISnZ SZ /"'j-
DRATNFIELD LENGTH UDTH & DEPTHU(��� #LINES SEPTIC TANK SIZE_ 'gyp:
DRAW A DETAILED PLOT PLAN BEL011. SEE INSTRUCTIONS. SOIL TYPE
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ANY CHANGE IN BUILDING OR SEI -AGE DISPOSAL PIANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMLT,7T.
DATE OF INSTALLATION SIGNATURE; OF APKICANT
APPROVED � DATE 1
5! 5l7 INSPECTED BY p A� HATE �� 7
SANITARIAN' S C%Yl
: C
IC"RTIFY THAT THIS SYSTEM '.%AS INST!,LLED IN THE MANNER APPROVED BY THE
HEALTH DEAPRTMENT DATE
INSTALLERS NAi\,iE
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