HomeMy WebLinkAboutSEP1981-00232 JEFFERSON COUNTY HEALTH DEPARTMENT
L� �'J 802 SHERIDAN AVENUE
INSTALLER v-&---(PC-77r", PORT TOWNSEND, WASHINGTON 98368 RECEIPT NO. -5 3
(206)385.0722
BUILDER SEWAGE DISPOSAL PERMIT DATE C —/r_��/
1 - 1 C( f Submit in Duplicate
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Owner Address / 7'7 7 C .(-e/. Phone r
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Directions for locating site t,
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INSTALL NEW SYSTEM x REPLACE SYSTEM ❑ PARTIAL REPAIR❑ TANK/DRAINFIELD N App 7-1
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TYPE OF NO. OF SITE
BUILDING BEDROOMS MCNX BASEMENT .SIZE 1 ( . N cn
DRAW DETAILED PLOT PLAN BELOW. STUB OUT PLUMBING ABOVE FOUNDATION FOOTING aco n
/�,' /� / SOIL LOGS n -c34" sca.A.5,.\0: , 0
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Dig two holes per site. (min.) co O
4' deep-2' dia. -50' apart & flag APPLICANT p m
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ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS (INCLUDING PLUMBING STUBOUT
LOCATION) AND/OR LOCATION OF HOUSE OR DRAINFIELD INVALIDATES THIS PERMIT UNLESS
PRIOR APPROVAL IS OBTAINED F' ou . • : • ' r u , __. '�.�3-;,
Drainfield Len•th \S< 1 Width ' De.th '5�'. # Lin-s Tank Size\' Gal. c
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COMMENTS: C -- (TWO COMPARTMENTS) 33
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APPROVED DATE INSPECTED PARTIAUFINAL DATE
I certify that this system was installed in a manner approved by the Health Department.
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INSTALLER'S SIGNATURE DATE DATE INSTALLED
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