HomeMy WebLinkAboutSEP1980-00210 TC 4 S E-Pg o o./IC) .
%._E t, I JEFFERSON COUNTY HEALTH DEPARTMENT . r i,
802 SHERIDAN AVENUE
VINSTALLER PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO. 22.0
BUILDER (206) 385.0722
SEWAGE DISPOSAL PERMIT DATE
Submit in Duplicate
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Directions for locating site ���!!
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INSTALL NEW SYSTEM e REPLACE SYSTEM Il PARTIAL REPAIR❑ TANK/DRAINFIELD❑Af. NO. OF t� X
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TYPE OF
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BUILDING-, BEDROOMS / BASEMENT 'C' SIZE
DRAW ETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING` 7 V Cl) o
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SOIL LOGS N o O
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Dig two holes per site. (min.) n
4' deep - 2' dia. - 50' apart & flag APPLICANT
Drainfield Length /ate Width 3O Depth M # Lines A Tank Size/OT2', Gal. `'
COMMENTS: D°veil (TWO COMPARTMENTS) c
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AP" VED DATE INSPEC ,E PA IAL/FINAL DATE
I certi that this s :tem �j 1 ::d in a manner ap by the Health Department.
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I TALLER'S SIG TU-E 111, DATE DATE INSTALLED
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