HomeMy WebLinkAboutSEP1973-00230^rnirt House
Fort Tohmsend Date 77
O"'NER //Qrn/d t)ai,8 ADDRESS/ HS jy- 17.J` Sf_ -- _ PHONE 6'E- S 6I9>
91 V9
DIRECTIONS FOR LOCATID'G SITE in 0,
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APPLICATION IS H.REBY MADE TO: INSTALL N=1' SYSTEM X REPAIR LXISTING SYSTEM
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N-AP^,E OF INT'&LL`'I2
903 F. Caroline OLYMPIC HEALTH DISTRICT
Permit No. ;? c
ST3`,
Fort Angeles r JSEVIAGE
DISPQS: L PERMIT APPLICATION
Sub,it in Duplicate
Builder
^rnirt House
Fort Tohmsend Date 77
O"'NER //Qrn/d t)ai,8 ADDRESS/ HS jy- 17.J` Sf_ -- _ PHONE 6'E- S 6I9>
91 V9
DIRECTIONS FOR LOCATID'G SITE in 0,
D k Pt f o -/ # g (o o N�iys i f +� PL
APPLICATION IS H.REBY MADE TO: INSTALL N=1' SYSTEM X REPAIR LXISTING SYSTEM
ca e,n
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fP-r, /-, j
,YPE OF BUILDING
N0. OF B DpCcMS
BA_S7,ENT
-SITE SI7
N-AP^,E OF INT'&LL`'I2
DRAINTIELD LEP;GTH Qu "LOTH .1 DEPTH f-icLIN;:.;, / ;I:iTIC TAi:K SIZE / ou o
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ANY CHANGE IN BUILDING OR ST! AGE DISPOSAL FLANS, LOCI",TION OR SITE, IPNALIDATES THIS
F'Ei iIT UNLESS PRIOR FFRC`J"L OT'Tr IDJT:D F 0 THE' HT'AITH E Tf RTM-NT
DATE OF INS TRLLATICH (o -y SIGr:'TL:.RF OF APPLICIIDTT
APPROVED �z
SANITARIAN'S CO[IIJ_-JTS:
Dl" �2' /�zb s s 61-
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DATE 5,21-71 INSFECTLD BY
DATE
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I CI RTIFY THAT THIS =)TFM '. AS Il°ST! LLED IN TH.,, MADIN3R AFPPOVED BY THE
HIL;ITH DEAP1,TI°:_1JT DATE I
903 E. Caroline
Port Ang6les
Court House
OLYMPIC HEALTH�DISTRICT
SEWAGE DISPQSAL PERMIT APPLICATION
Submit in Duplicate
Permit No,
Builder
Fort Townsend Date
04ir1ER�a,2,,, &5
Qre/d Da VIS ADDRESS I/�S'C _�,,_ ,97,1 Zd S? PHONE YE- S 6147
DIRECTIONS FOR LOCATING SITE Far�,r .,o z% oh
APPLICATION IS HEREBY MADE TO: INSTALL N-7' SYSTEM X REPAIR SXISTING SYSTEM
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DRAINFIELD LENGTH �O "IDTH ;2 DEPTHS -/o' #LINES / SEPTIC TANK SIZE loo n
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ANY CHANGE IN BUILDING CR SL.'AGE DISFOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERPIIT UNLESS PRIOR - PROV"L O)TAINTED FROM THE IMALTH DEPT RTNI NT
4-
DATE OF INSTALLATION SIGIU,TURE OF APPLICANT
APPRWIM _ DATE S- 21-E3 INSPECTED BY DOTE
SANITARLaD"S C01111:NTS:
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I CIRTIFY THAT THIS SYSTEM '.'AS INSV°LLED IN THE MANNER AFPROVED BY THE
HE."I.TH DEAPRTM--NT DATE
IPTSTALLERS Nri!°iE
YPE OF. BUILDING I A'0. OF B -DROOPS
AASEAIENT
SITE SI'L
P?0.11E OF INSTALLER
DRAINFIELD LENGTH �O "IDTH ;2 DEPTHS -/o' #LINES / SEPTIC TANK SIZE loo n
'�" �'CL-o.
ANY CHANGE IN BUILDING CR SL.'AGE DISFOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERPIIT UNLESS PRIOR - PROV"L O)TAINTED FROM THE IMALTH DEPT RTNI NT
4-
DATE OF INSTALLATION SIGIU,TURE OF APPLICANT
APPRWIM _ DATE S- 21-E3 INSPECTED BY DOTE
SANITARLaD"S C01111:NTS:
��++ pay .1' ✓n 2�+ 5 s'�7- (>H�k �c!/ c++ilX dam!/ vnckr � ,)- '- Inat�!! hor•••�!
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I CIRTIFY THAT THIS SYSTEM '.'AS INSV°LLED IN THE MANNER AFPROVED BY THE
HE."I.TH DEAPRTM--NT DATE
IPTSTALLERS Nri!°iE