HomeMy WebLinkAboutSEP1973-00271 i,..cte,,//...1.51, i .. . • 9 999' 9,
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903 E. Caroline OLYMPIC HEALTH DISTRICT Permit N o
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Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Court House ,
Port Townsend Date /j -,Z3
�i e/ �-�1, // box 505
OWNER t'�DDRESS` „ +k.\„ ,,; PHONE
DIRECTIONS FOR LOCATING SITE - ,�, ;. S
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APPLICATION IS H 2..:BY MADE TO: INSTALL NEW SYSTEM i,/ REPAIR EXISTING SYSTEM
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TYPE OF UILDiiNG NO. OF BEEROOi'S BASEMENT SITE SIZ NAME OF INSTALLER
DRAINFIELD LENGTH , ''IDTH./S" DEPT#LINES/X SEPTIC TANK SIZE 75c.
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. iQQ 18"8.trt ---'r C\w�•
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ANY CHANGE IN BUILDING OR SE' AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS ^
PERMIT UNLESS PRIOR : PPROV^:L OTBTAINED FROM THE HEALTH DEPARTMENT. .S)
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DATE OF INSTALLATION �/',Pb�J 5 SIGNATURE 0 : •P.-- !NT)S A z..9— OD
PLAN APPROVED v DATE INSPECTED BY - ..,-- DATE -, .9.- -3 •',
SANITARIAN'S COP MaiTS: tc�.c-. sc qS bs."\.1 ^ C� , ,.,,,, ,N.\...1 - �. vk v.cc ` e>
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I CERTIFY THAT THIS S i ''A j, INST'.LLED IN THE MANNER APPROVED B�/T�
HEALTH DEAPRTMENT?`, $ 7� ,,.4yZ. 1 DATE /24/73 _
Il`1STALLERS NAME
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Mari a I I
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ININ 111 __II
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