HomeMy WebLinkAboutSEP1975-004936iEPlS- 4g 3
903 E. Caroliae OLYMPIC HEALTH DISTRICT -
Permit No. �53�
Port 'Angeles SEWAGE DISPOSAL PERMIT APPLICATION
S_ubmii.t in Duplicate
Buildgx
Court House
'" `�'
' Port Townsend
Date_,5 /%� __
—PHONE eo3- m3
DIRECTIONS FOR LOCATING SITE
�X%x Acme �t�
APPLICATION IS HEREBY MADE T0: INSTALL NEW SYSTEM AIR EXISTING SYSTEM
YP�BUI
OF
I
ING
N0. BFDFi00MS
I BASEMENT SITE SIZ
N
OF S ALLER
DRAINFIELD LENGTH 35. _4tIDTH (qDEPTHvZ SEPTIC
TANK SIZE a
DRAW A DETAILED PLOT PLAN BELOW. SEkwRUCTIONS. SOIL TYPE
LA
2-4
1
------------6'
P✓
A ANGE IN BUI ING ORS $GE ISPOSA PLANS MCATION OR . ;AiIDA 'K rS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FRCM THE HEALTH DEPARTMENT.
DATE OF (INSTALLATION SIGNATURE OF APPLICANT
(Q�
APPtZROVE� ✓ DATE INSPECTED BYE ���DATE
Cv Q
SANITARIAN'S COMMENTS:
O
IN LIED IN THE MANNER APPROVED
I CERTIFY THAT THVVZ
BY THE
HEALTH DEAPRTMENT -I-
-znamr
A
_
s
6iEPlS- 4g 3
903 E. Caroliae OLYMPIC HEALTH DISTRICT -
Permit No. �53�
Port 'Angeles SEWAGE DISPOSAL PERMIT APPLICATION
S_ubmii.t in Duplicate
Buildgx
Court House
'" `�'
' Port Townsend
Date_,5 /%� __
—PHONE eo3- m3
DIRECTIONS FOR LOCATING SITE
�X%x Acme �t�
APPLICATION IS HEREBY MADE T0: INSTALL NEW SYSTEM AIR EXISTING SYSTEM
YP�BUI
OF
I
ING
N0. BFDFi00MS
I BASEMENT SITE SIZ
N
OF S ALLER
DRAINFIELD LENGTH 35. _4tIDTH (qDEPTHvZ SEPTIC
TANK SIZE a
DRAW A DETAILED PLOT PLAN BELOW. SEkwRUCTIONS. SOIL TYPE
LA
2-4
1
------------6'
P✓
A ANGE IN BUI ING ORS $GE ISPOSA PLANS MCATION OR . ;AiIDA 'K rS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FRCM THE HEALTH DEPARTMENT.
DATE OF (INSTALLATION SIGNATURE OF APPLICANT
(Q�
APPtZROVE� ✓ DATE INSPECTED BYE ���DATE
Cv Q
SANITARIAN'S COMMENTS:
O
IN LIED IN THE MANNER APPROVED
I CERTIFY THAT THVVZ
BY THE
HEALTH DEAPRTMENT -I-
-znamr
A
_
s