HomeMy WebLinkAboutSEP1976-00270 /110116rrOW, 7Q-n jc, SEP 16 —Q0 170
903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No. 3 ore,4 .
Port Angeles, Wash. SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Courthouse
Port Townsend, Wash. Date
OWNER 1)Ll Al f, �I/ r 0 R go tC✓ ADDRESS f;.2 , '"' PHONE
DIRECTIONS FOR LOCATING SITE (ennab- „?( Iii d — J6kte.0 iro, te,....E'"�`.
ON 0&) ,o- Gzd
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM /REPAIR EXISTING SYSTEM
FR,447E-ti)00D Ca4..n 1 .• 1� 0- _ Q 6.ei-Q�. -31A,v (�. ND1�W1art2 .
TYPE OF BUILDING NO. OF BEDROOMS BAS��� 01: SITE SIZE NAME OF INSTALLER
DRAINFIELD LENGTH/Q( WIDTH )-a ttDEPTH -LI'. LINES 04- 'EPTI TANK SIZE \O )- -Q-
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE `j -Ns�,Sa \
t C}1tMAcuM till
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WELL SO o �� (2)R 1 L 610
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ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM,,THE HEALTH DEPARTMENT.
AE INSTALLATION SIGNATURE OF PP i ' 1 'l Ifti
APPROVED ,L� DATE Co�,Z9 ](0 INSPECTED BY 1116, 1114 �`,',- DATE / - _
SANITARIAN'S COMMENTS: -S . `/I _ 1 .:,,ps., 5 \ ys a,c, v
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I CERTIFY THAT THIS SYSTEM WAS INSTALLED IN THE MANNER APPROVED BY THE HEALTH 2.)
DEPARTMENT DATE
INSTALLERS NAME `
OHD 6-75 `� 's-z..-` (‘-"-. "�-�`l- t..r'-"')
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