HomeMy WebLinkAboutSEP1978-00371 JEFFERSON COUNTY HEALTH DEPARTMENTSCep"19 _3---/ 1e . .•
802 SHERIDAN AVENUE
INSTALLER �Ii- °i 4-1- PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO. /, ' 7
BUILDER (206) 385.0722
SEWAGE DISPOSAL PERMIT DATE —7r
Submit in Duplicate
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INSTALL NEW SYSTEM [,�51 REPLACE SYSTEM 0 PARTIAL REPAIR El TANK/DRAINFIELD❑
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TYPE OF -.,, NO. OF j ,q� SITE 747- .7.1-y°
BUILDING BEDROOMS Z BASEMENT / �' SIZE �:3e�AjJ - / fS,�j� m
DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING co 0
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Dig two holes per site. (min.) R
4' deep - 2' dia. - 50' apart & flag APPLICANT
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Length/00/ Width 'G4 Depth"
? # Lines 121, Tank Size )al.
COMMENTS: (i ,/i� C7� `%j /`/ °6 %U ''` v (TWO COMPARTMENTS) D
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• PPROVEP DATE INSPECTE! PA' IAL/. AL DATE
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I certify that this ystem was installed in a manner appr.ved by the Health Department.
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INSTALLER'S SIGNATURE DATE DATE INSTALLED
JCHD/1-78
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