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903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No*•
Port Angeles SDIAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
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Court House
Port Townsend Date
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DIRECTIONS FOR LOCATING SITE
APPLICATION IS HEREBY MADE TO: INSTALL Nal SYSTEM vRREPAIR EXISTING SYSTEM
IYPE OF BUILDING NO, OF BEDROOMS BASDrIENT 1 SITF IZA `NAME OF TRATALUM
DRAINFIELD LENGTH ►IDTH�. 02 9 DEPTH g_ #i LINES ` SEPTIC TANK SIZE ;z) cz,, c's
DRAW A DETAILED PLOT PLAN BELM1. SEE INSTRUCTIONS, SOIL TYPE �.
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ARY CHANGE IN BUILDING OR SLIAGE DISPOSAL PIANS, LOCATION OR SITE, INVALIDATES MIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMIZIT,
DATE OF INSTALLATION /;)/7-0 SIGNATURE OF APPLICANT
APPROVED
DATE l INSPECTED BY c DATE 7
SANITARIAN'S C01WIETS : .�'�."'�'.._....`...
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ROVED BY THE
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