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HomeMy WebLinkAboutSEP1974-00264Spe-ncer, s9 d 903 E, Carolaxte, OLYMPIC HEALTH DISTRICT Port Angeles SEWAGE DISPOSAL PERMIT, APPLICATION 56v 71'/-00 Permit xe. Submit in Duplicate Builder Court House Port Townsend Date !e L ,OWNER _ 5 c - _ADDRESS \ 'S A . _\.,% PHONE '31-�5s z DIRECTIONS FOR LOCATIN SITE ""-APPLICATION IS HIEREBY'M TO:. INSTALL N-71.1 SYSTEM r REPAIR EXISTING SYSTEM YPE OF BUILDING NO. 470 OMS $ASEFIENT SITE SIZ NAME OF INSTALUR __. ..... _ r. _ . __.. _ .. __.... _ , � • � ��,` 'Q -mac ` DRAINFIELD LENGTHi ''IDTH L.Q.DEPTH#LINES SEPTIC TANK SIZE �%5© DRAW A T . -DE .► ��INSTRUCTIONS. SOIL TYPE( -;-5 � c� y ANY CHANGE IN BUILDING OR S AGE DISPOSAL FLANS, LOCATION OR SITE, INVALIM PER1viIT UNLESS PRIOR APPROVAL OBTAINED FRON THE HEALTH DEPARTMENT, DATE OF INSTALLATION SIGNATURE OF APPLICANT A.PPR m DATE A%`1 INSPECTED B SANITARIAN'S CO1d'1Z TS: Y 1 I CERTIFY THAT THIS SYST S �; MANNER APPROVED BY T HEALTH DEAPRTMENTN IADATE CK S ALLE NAME rrs- _ ZDkTE j I HE , Map Output Page 1 of 1 ArcIMS HTML Viewer Ma sof 9 7 Legrnd JC -Rands Q Assessor Maps#1 Psrosia4l 2011 As" Pfwiw 9 T8�30U� i 34 s� M*mWamodq Jewsm CW*jca" 9 CIS 766f1001 ti 768EfifDt: ' 9i eaoo ... FOR INFORMATIONAL PURPOSES ONLY - Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect roueits correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Jul 03 12:50:41 2012 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=o... 7/3/2012