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HomeMy WebLinkAboutSEP1974-00047903 E. Caroline Port Angeles Court House Port .rTown.sen,d Iv. ' w OLYMPIC HEALTH DISTRICT Permit No,�� SEWAGE DISPOSAL PERMIT APPLICATION Submit is Duplicate:- Builder ZA, Dat , Banlau P. 6Wn•,,. 19539 DIRECOTIONS FOR LOCATING SITE\�Co�� APPLICATION IS HEREBY MADE TO: INSTALL NaSYSTEM i­�PAIR EXISTING SYSTEM L -�� a-37 BU YPE OF ILDING0 OF BEDROOMS BASEMENT SITE SIZ AME OF INSTALLER DRAINFIELD LENGTH`.41IDTH -�I DEPTH#LINE:S�1 SEPTIC TANK SIZEv�, DRAW A DETAILED PLOT PLAN BE?AW, SEE INSTRUCTIONS. SOIL TYPP\7a �\ ti UNLESS PRIOR AL OBTAINED FROM THE HEALTH DEPARTMENT, 0 DATE OF INSTALLATION"— SIGNATURE OF APPLICANT R DATE Z 2 INSPECTED BY .� �� Fe s� DATE SANITARIAN'S COMMENTS: a I CERTIFY THAT T IN THE MANNER APPROVED BY THE HEALTH DEAPRTMENT DATE ��e���-L/��'�oc Vi, Ke, v,', Hyl"/ ✓ may'® �✓` w 903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No._I_? Port Angeles SEWAGE DISPCSAL PERMIT APPLICATION Submit in Duplicate BuilderOx",rl� Court House Port Townsend Date -w-117V OAR Jai , l? fu J'' ADDRESS P. ©.. goX �rf ,�5� %VIy®%V PHONE '— DIRECTIONS FOR LOCATING SITE /Wf. /bJ S. Tv /h�(! sightr�i'�eQc�ise//s� lags i�pt�left 9 ®B J �' �y f APPLICATION IS HEREBY MADE T0: INSTALL N34 SYSTEM4Y REPAIR EXISTING SYSTEM *0 JZ37 YPE OF BUILDING �N0_. OF BEDROOMS BASEMENT SITE ST 11 NAME OF INSTALLER DRAINFIELD LEPJGTH=' VDTH DEPTHIF ' #LI114ES_�L SEPTIC TANK SIZE /000 ga I DRAT! A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. -___SOIL. TYPE 6P&VP_l/V,54ndVocicty. �RYM� NJI 1 K� MIM X10AIN ` \ �.py^cc /10` ft• 9;etwe-,# We/ia c® e >aper7��o .6517v f W00cfed ,#// oven, eL MIT UVL] 5 PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT. DATE OF INSTALLATION SIGNATURE OF APPLICANT APPROVED DATE INSPECTED BY SANITARIAN'S COPIMENTS: I CERTIFY T14T THIS SYSTEM 'JAS INSTALLED IN THE MANNER APPROVED BY THE HEALTH DEAPRTMENT PATE INSTALLERS NAME DATE