HomeMy WebLinkAboutSEP1973-00085903 E. Caroline
Port Angeles
73- ov&5
OLYMPIC HEALTH DISTRICT i� �� �t No.
SEWAGE. DISPOSAL PERMIIT APPLICATION
Submit in Duplicate Builder
Court House
Port Townsend Date 1 !3
OWNEP=-ADDRESS Yr's �� i�s�'v , PHONE �
DIRECTIONS FOR LOCATING SITE
APPLICATION IS HII2EBY MADE TO: INSTALL Nal. SYSTEM PAIR EXISTING SYSTEM
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DRAINFIE7,D LENGTH1C� ! WIDTH_ _DEPTH � �#LINk SEPTIC TANK SIZE
DRAM A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE
DP
PERMIT UNLESS
APPROVAL OBTAINED rprw Tur T'M.1kT.rr9 nr.DA'0n%T hTM
D4ZE OF INSTALLATION SIGNATURE OF APPLICANT_
APPROVED -/ DATEINSPECTEDBY
SANITARIAN'S CO111ENTS : DATE a
ROVED BY THE
DATE
E Of. BUILDING
NO. OF BEDRNM
I BASEMENT
SITE SIZ
NAME OF INSTALLER
f a �o e�sa}� �
DRAINFIE7,D LENGTH1C� ! WIDTH_ _DEPTH � �#LINk SEPTIC TANK SIZE
DRAM A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE
DP
PERMIT UNLESS
APPROVAL OBTAINED rprw Tur T'M.1kT.rr9 nr.DA'0n%T hTM
D4ZE OF INSTALLATION SIGNATURE OF APPLICANT_
APPROVED -/ DATEINSPECTEDBY
SANITARIAN'S CO111ENTS : DATE a
ROVED BY THE
DATE