HomeMy WebLinkAboutSEP1971-00137'J
g03 East Caroline OLYMPIC HEATH DISTRICT Court House
Port Angeles bort Townsend
a 7TLDT NG STT_F, Tip Si T'"1?,' �PP'LICA'I`TOF
Submit a.n Du 'ev ,e
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OWNER ADDRESS DATE --
LEGAL DESCRIPTION /SWAP a,- A15A. e-/S-'TWws�,D• X''%14)
DIRECTIONS FOR LOCATING SITE
AN APPLICATION IS HEREBY MADE('OR APPROVAL OF THE ABOVE LOCATION FOR A
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
RESIDENCE -:XeS COMMERCIAL BUILDING OTHER
NO. BEDROOMS- BASEMENT SITE SIZE ZSAC- V co�'SOURCE OF WATER,
TYPE OF SOIL, DEPTH TO WATER TABLE�..ja_
D'EA� �� in the space belowl indicating location of building in rel'! -..on
to other buildings, property lines, well, streams or other bodies of water,
Indicate proposed location of sewage disposal system*
a, 4
Date of Sie Inspection S S 1-71
Approved* "� Disapproved
* See reverse side for remarks.
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THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PBP1Y1:; 10-
NECESSARY
SNECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.