Loading...
HomeMy WebLinkAboutSEP1975-00055_$'EP7.r; ooS P,- 903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No, Port Angeles .."1-S11cSEV1AGE DISPOSAL PERMIT APPLICATION Submit in Duplicate Builder Court House Port Townsend bate �F- 19da 1-1803 MMRIMA Sow, 6uMSPT ADDRESS 32 rs A/�i�,�,�YpFPHONE �L ''0 0 � DIRECTIONS FOR LOCATING SITE __.DA S O 8 Jkq C %Z� APPLICATION IS HEREBY MADE TOi INSTALL N34 SYSTEM�- REPAIR EXISTING SYSTEM OF BUILDING 1 NO.. OZ © BEDROOMS 1 BA ENT t SITE IZA NAME O�j� Li DRAINFIELD LENG !,DTH DE.#LINES .L SEPTIC TANK SIZE 7 LU DRAW A DETAILED PLOT PLAN BELOW*- SEE INSTRUCTIONS. SOIL TYPE - -— . I 9f, 1:14*P6 11 !4 1 y.,-- PRIOR APPROVAL OBTAINED.FROM THE HEALTH DATE OF INSTALLATION SIGNATURE OF APPLICANT' DATE l INSPECTED BY - Sa�ANITARIAN'S COPtMIIVTS DATE 0 I CERTIFY THAT THIS SYSTEM 4rAS IIS?STALLED IN THE MANNER APPROVED BY THE Q HEALTH DEAPRTMx. LIT _____,PATE INSTALLERS NAME �, .. `I .. - -:i -•�. a , � �'��'`:�� � � � ,moa � ��, i' �►-� u �,.� 'c.. ��,{, e � � �I 6 / � c Tai