HomeMy WebLinkAboutSEP1975-00087r
903 E. Caroline
Port Angeles*",-,
Court House
Port Townsend
b" n a _L
DIRECTIONS FOR LOCATING
OLYMPIC HEALTH DISTRICT Permit No.
SEWAGE DISPOSAL PERMIT APPLICATION
Submit in; Duplicate rS,,,, Builder .
�.y� na _ po rG a 163 &�,, , w nate C.
APPLICATION ,IS HMMY MADE T60! INSTALL N -W SYSTEM .W REPAIR EXISTING SYSTww
YPE OF .BUILDING' NO. QF BEDROOMS EMENT SI1V IZ N M i 01'`I
DRAINFIELD LENGTH �,�:: a�f '�jIDTH -,L DEPTH mat, SEPTIC TANK SIZE
DRA41 A DETAILED PLOT PIAN"BELOW. SEE "INSTRUCTIONS. `SOIL TYPE = '.
. +...,Vea i.a,VLv ....,. Nii.0 �. .Lt1Y•A,u.a.Lr►i Am..
.ill.a.aa
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THt HEALTH DEPARTMENT.
DATE QF INSTALLATION�`
SIGNATURE OF APPLICANT`S^'`; �l�G; �`'��� ' •�.�. ....�
A17PR_' DATE w A r° • INSPECTED BY�c�L,.s a DATE /3 '.
SANITARIAN'S COMMENTS: --J�
0
I CERTIFY THAT THIS SYS3"EM vAS INSTALLED IN THE MANNER APPROVED BY THE
HEALTH DEAPRTIMiT , ;, � y$; ,�,.. DATE
INSTALIiS NAME