HomeMy WebLinkAboutSEP1974-002559^ 'E..Caroljne OLYMPIC HEALTH DISTRICT Permit No.
Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate Builder
Court House
Port Townsend Date %d o2W
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NER� • �•A\��`, 5 ADDREss S S �� 5,•,y,�,..� �o�� PHONE
DIRECTIONS FOR LOCATING SITE
APPLICATION IS H'' =Y MADE TO. INSTALL N34 SYSTEM REPAIR EXISTING SYSTEM
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DRAINFIELD LENGTH lIIDTH DEPTH #LINES SEPTIC TANK SIZE
ANh ORANGE IN BUILDING OR SE!AGE DISPOSAL PLANS, LOCATION OR SITE, I ALI ATESTHIS
PERMIT UNLESS PRIOR APPROVAL OBTAINEDFROM THE HEALTH DEPARTMENT.
DATE OF INSTALLATION SIGNATURE OF APPLICANT
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APPROVED DATE 12Id'117'1 INSPECTED BY DATE
SANITARIAN'S COMMENTS. -
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I CERTIFY THAT THIS SYSTEM S(AS INSTALLED IN THE MANNER APPROVED BY THE
HEALTH DEAPRTMEIiT
NSTALLERS NAh1F.
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