HomeMy WebLinkAboutSEP1974-00065�-Oeladc, a -o
903 E. Caroline
Port Angeles
OLYMPIC HEALTH DISTRICT
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate
Court House
Port Townsend
OtJ1VER �1C/,2� �C'l ® ADDRESS
DIRECTIONS FOR LOCATING SITE ,� Rj) 0 A Lei_
Permit No.
Builder
Date -%
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APPLICATION IS HIREBY MADE TO: INSTALL N -3f SYSTEM REPAIR EXISTING SYSTEM
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LI�P?f BUILDIN1G N0. OF BEDROOMS B TENT SITE STZ NAME OF INS AL
DRAINFIELD LENGTH '_1IDTH j' ®
'DEPTH#LINES
2-- SEPTIC
TANK SIZE 73-3 FI&AG .
DRAW A DETAILED PLOT PLAN
BELOV!.
SEE INSTRUCTIONS.
SOIL _TYPE
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PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
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DATE
��F INSTALLATION SIGNATURE OF APPLICANT��,
DATE 'jINSPECTEDBY_ ��� c_.�+�'�DATE
SANITARIAN'S COMMENTS:
I CERTIFY THAT THIS SYS . '."AS IA?ST!iL APPROVED BY TIJE
HEALTH DEAPRTMENT ;2t-4C�I _DATE / 7 /7y
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