HomeMy WebLinkAboutSEP1975-0044815/ sh rarl 4,o
903 E. Caroline OLYMPIC HEALTH DISTRICT Permit No.„�'�
Pont AngelesSEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate ilaer,y&4Qf*_e
Court House ,
�,� Date
Port Town nd .
KA
ADDRESS / PHONE �t' . ,,?
.DIRECTIONS FOR 'LOCATING SITE 6► �.�.! '
APPLICATION IS HEREBY MADE TO:* INSTALL NEW.SYSTEMX_REPAIR EXISTING SYSTEM
_.f YP O�LDII iNO, 0 EDROOMS BASEMENT SITE SIZA AME ;fix
DP.AINFIEID LENGTH ee/1+.1IDTH�_ DEPTH#LINffi SEPTIC .TANK SIZE.. e �.
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE
V.'
gt
ANY CHANGE IN BUI ING OR SVI AGE,DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT,
DAEE OFINSTALLATION u SIGNATURE OF APPLICANT
APPP ✓ DATE PECTED BY
SANITARIAN'S COMMENTS:
DATE
ER APPROVED BY THE
DATFI
59
s>
-b
m
-o
-b
x
--I
m
O.
cl
r-1-
x
Q
m
O
—
-o
m
C
O_
m
m
-
--
m
(C
r+
O
m
#i
E
-s
O
7
O
®
n
O
-P
-7
O_
O
J
' ^
W
co
-1
W
H
-p
CO)
O
Z
O
O
-P
O
-P
-P
O
C
ca
C]
O
rF
—
m
T1
\
rF
H
r
CA
G7
-O
C
CA
O
m
m
m
N
S
—1
3>
O
co
m
3
OD
—i
-P
O
n
DC
-
c
Q
Z
;K
m
—I
1?
U7
a
m
m
O
\
x
r
co
m
a
--I
w
m
r
a
J
r
--I
-•
m
m
--�
O
J
-P
C2
.A
H
—+
C
C-3
r-
0
m
w
c
�
Q.
C-3
O
c
CL
m
CD
m
J
J
O
O
—1
V
O
Z
m
n
n
o -
CD
3
S
7'
1
(O
(O
O_
CA
H
c
O
n
Z
to
r+
O.
G7
'i
CD
m
ro
\
co
Cl)
c
C3
O_