HomeMy WebLinkAboutBLD1997-00659 7aNykr-, PA A , ''EfFM, --C)OC) 1 ,
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903 E. Caroline OLYMPIC HEALTH .DISTRICT Permit No.
Port Angeles, Wash, SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Courthouse
Port Townsend-11, Wash, ' I t Date ,,�/1 7 7
OWNER J 4, 7/`779 R,f e)R ADDRESS; 4E/YA//s' I. V b , PHONE
DIRECTIONS FOR LOCATING SITE 2/V ,Ozwil/%S 49Ji/,'p, lor/7 1 di/, 2" C",c -~-
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APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM REPAIR EXISTING SYSTEM
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TYPE OF BUILDING NO. OF-BEDROOMS BASEMENT SITE SIZE NAME OF INSTALLER
DRAINFIELD LENGTH WIDTH DEPTH *LINES SEPTIC TANK SIZE 7 5 D
DRAW A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE
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ANY CHANGE IN BUILDING OR SEWAGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES THIS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
DATE OF INSTALLATION SIGNATURE OF APPLICANT,,, ,,, ;4 ,0`
APPROVED DATE INSPECTED BY DATE �.Q
SANITARIAN'S COMMENTS: k 5 ` P'
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I CERTIFY THAT THIS SYSTEM WAS INSTALLED IN THE MANNER APPROVED BY THE HEALTH C
DEPARTMENT DATE
INSTALLERS NAME a%
OHD 6-75