HomeMy WebLinkAboutSEP1975-00492r
903 E. Caroline
Port Angeles, Wash.
Courthouse
Port Townsend, Wash.
OLY14PIC HEALTH DISTRICT Permit N 3" Y
A.
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder `J
Date to /7- 7.57 -
OWNER U,ze yr & 9s ADDRESS PHONE
DIRECTIONS FOR LOCATING SITE /loo'' wrll o� ylir7 �ar��✓iw�riJ %�oyaail 'r„�PGrjs
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APPLICATION IS HEREBY MADE T0: INSTALL NEW SYSTEM__REPAIR EXISTING SYSTEM
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TYPE OF BUILDING I NO. OF BEDROOMS
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SITE SIZE I NAME OF INSTA.
DRAINFIELD LENGTH 130 WIDTH -DEPTH /8 #LINES 3 SEPTIC TANK SIZE /000
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE
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ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FR 4I3 THE HEALTH DEPARTMENT.
SIGNATURE OF APPLICANT ^)
�SPECTED BY DATE 0
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DATE OF
APPROVED EEK DATE is
SANITARIAN'S COMMENTS:
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I CERTIFY THAIT THIS SYSTEM S
OHD 6-75
IN 1
THE MANNER APPROVED BY THE HEALTH OX24V
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903 E. Caroline OLYMPIC HEALTH DISTRICT Permit N
Port Angeles, Wash. SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Courthouse
Port Townsend, Wash. Date lo- /7- 7S
OWNER 6u a./e,o
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ADDRESS
PHCNE
DIRECTIONS FOR
LOCATING SITE /op'
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APPLICATION IS
HEREBY MADE TO,
INSTALL NEW SYSTEM.X.REPAIR EXISTING SYSTEM
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TYPE OF BUILDING NO. OF BEDROOMS BASEMENT SITE SIZE NAME OF TALLER
DRAINFIELD LENGTH (jo WIDTH_DEPTH /8 #LINES 3 SEPTIC TANK SIZE /OC7O
DRAW A DETAILED PLOP PIAN BELOW. SEE IIOSTRUCTIONS. SOIL TYPE
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ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
DATE OF INSTALLATION SIGNATURE OF APPLICANT
APPROVED DATE /o-/7-7,' INSPECTED BY DATE O
SANITARIANIS CATS• . :ii be /ofo{•� o.e TR< /. •t ( _ /e.e/ errq 1
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I CERTIFY
OHD 6-75
IN THE MANNER APPROVED BY THE HEALTH AM 2:x VB
DATE Ti
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