HomeMy WebLinkAboutSEP1974-00258j1 7'),
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903 E. Caroline
Port Angeles
I OLYMPIC HEALTH DISTRICT
SDIAGE DISPOSAL PERMIT APPLICATION
Permit No.
Submit in Duplicate Builder
Court House ct
Port Townsend Date
WNER PH
ADDRESS -;k- -Ic-
O
MPH
DIRECTIONS FOR LOCATING SITE
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APPLICATION IS HEREBY MADE TO: INSTALL Nal SYSTEM FAIR EXISTING SYSTEM
rYPE OF BUILDING] NO, OF BEDROOMS I BASEMENT.1 SITE SIJ OF
DRAINFIEID LENGTH SO IJID 3 DEPTH Q1-3,."#LINES SEPTIC TANK S IZE :15
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL
-ANY-CHANGE-IN BUILDING OR SE' ,AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM ,THE HLALTH DEPARTMENT, A
DATE OF INSTALLATION SIGNATURE OF APPLICANT'
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L�ROV
APPROV DATE 44V&INSPECTED BY < D'
ATE
SANITARIAN'S CONMENTS: v
I CERTIFY THAT TH
D IN THE MANNER APPROVED BY THE
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HEALTH DEAPRTMEEN
N
DATE