HomeMy WebLinkAboutSEP1974-00067I -�
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903 E. Caroline
Port Angeles
SEP74- 0067
OLYMPIC HEALTH DISTRICT Permit No,%c�tt
SLWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Court House
Port Townsend At, at / , ' , h GH
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DIRECTIONS FOR LOCATING SITE1 �=�'— �� JAID
APPLICATION IS H12EBY MADE TO: INSTALL N24 SYSTEM PREPAIR EXISTING SYSTEM
YPUILDING NO. OF BMR . BAS�F�IENT V ,,SIIZ 0. AME�O INst fx R f 7,—
DRAINFIELD WDEPTH#LINFS�]LSEPTIC TANK SIZE
DRAW A DETAILED PLOT -PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE d IT Av 4- v
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PERMIT UNLESS PRIOR APPROV A L OBTAINED FROM THE HEALTH DEPARTMENT,
DATE OF INSTALLATION
SIGNltTURE OF APPLICANT I,
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INSPECTED BY _ C, �� c_-�s�
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DATE?/77
SANITARIAN'S COMMENTS:
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I CERTIFY THAT THISJM
','AS DIST L INT NN APPROVED BY THE
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HEALTH DEAPR 1
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IP STALLERS NAME
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701282001
GOVT LOT 1
(RES FOR PARK)
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(SW 1/4 21 -27N -1W)
(SW 1/4 28 -27N -1W)
JEFFERSON COUNTY