HomeMy WebLinkAboutSEP1973-001183 gy.�3 71I'
903 E. Caroline OLYMPIC HEALTH DISTRICT
Port Angeles SEWAGE DISPOSAL.PERMIT APPLICATION
Permit No. (,�.
Submit in Duplicate, Builder ---
Court House
Port TownseAd Dateyrj"\ \i3
04I1VER�-.� ADDRESS PHONE
DIRECTIONS FOR LOCATING SITE ti �� ,� ,,� i60
APPLICATION_ IS, HEREBY MADE TOi.INSTALL N31 SYSTU ✓REPAIR EXISTING SYBT-EM
YPE OF BUILDING NO. OF BEDROOMS I BASEMENT I SITE SIZJ NAME OF INSTALLER
DRAINFIELD LENGTH \fid ►IDTH ;tVi, DEPTH ;U*4i"#LINES. A SEPTIC TANK SIZE,
DRUJ- A -SETAILED PLOT PLAN BELOV1. SEE INSTRUCTIONS- SOTT, TYPE
CA
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CHANGE„IPt BUIIDI G OR.SE'AGE DISPOSAL' PLANS, LOCATION OR SITE, INVAMAT THIS
PERMIT UNLESS PRIOR,APPROVAL OBTAINED FROM THE HEALTH DEPARTMaTT.
DATE OF INSTALLATION
\1 7 S IGNttTtTRF OF APPLICANT
APPROVED
SANITARIAN'S COMMENTS: DATE 16 bi h3 INSPECTED BY ��� i��i3 DATE__
I CERTIFY THAT THIS
HEALTH DEAPRTM,�I'' TT.>'
L—
MANNER APPROVED BY THE
DATE
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