HomeMy WebLinkAboutSEP1979-00226 • JEFFERSON COUNTY HEALTH DEPARTM -<T g/15 y
802 SHERIDAN AVENUE ///�
INSTALLER PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO. ?U D 7
(206) 385-0722
BUILDER O INCC!- DATE `g/, ",7
SEWAGE DISPOSAL PERMIT
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Directions for locating site 5°
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INSTALL NEW SYSTEM tl CI SYSTEM ❑ PARTIAL REPAIR TANK/DRAINFIELD❑ R DD
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TYPE OF NO. OF SITE fk
BUILDING BEDROOMS BASEMENT ( .SIZE I / ',eE` cn. m
DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING `)(
1\164,, 6�1N.40 Nci. SOIL LOGS S-� S `,-- 0_c', o
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' Dig two holes per site- (min-) co 0
4' deep -2' dia- -50' apart & flag APPLICANT" y I/` 2� ' rrie� O m
ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING PLUMBING STUBOUT (=,
LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES THIS PERMIT UNLESS
• PRIOR APPROVAL IS OBTAINED -F•1u . . e . 1 _----- -
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Drainfield Len•th C, Width De.th # Lin-s Tank Size r!.,'` Gal. c
COMMENTS: S-c`- (y , 3 is — A-...1 -y, .� (TWO COMPARTMENTS) r DJ
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APPROVED DATE INSPECTED PARTIA FINAL ATE P�Mg4,(z�hl W
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• certify that this system was installed in a m/anner approved by the Health ent. j' • + f we_
INSTALL 'S SIGNATURE DATE DATE INSTALLED
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