HomeMy WebLinkAboutSEP1970-001280
- �Eo 70- e5o t 28
903 East Caroline OLYMPIC HEALTH DISTRICT Count House
Port Angeles Port Townsend.
BUILDING SITE INSPECTION APPLICATION
Submit in Duplicate
OWNER `�'T E!O � ADDRESS ` G DATE L
LEGAL DESCRIPTION
DIRECTIONS FOR LOCATING SITE
V
AN APPLICATION IS HEREBY MAE FOR APPROVAL OF THE ABOVE LOCATION FOR A
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
RESIDENCE._.L COMMERCIAL BUILDING OTHER
NO. BEDROOMS BASENEN SITE SIZE_ �OOURCE OF WATER_ VC�/j9Z A- f led—
TYPE OF SOIL DEPTH TO WATER TALE+fir ,T
Q:RAW A SKETCH in the space below* indicating location of building in relat3.on
to other buildings, property lines, well, streams or other bodies of water.
Indicate proposed location of sewage disposal system.
Wx 1 to
�h dIL&'e , 0,c e .
'A'—/eg ld `i r
a r
Date of Site Inspection APPLICANT'S SIGN
Il�rrrPrll�r
Approved* Disapproved
Qr
* See reverse side for remarks. Sanitarian
THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PERMIT ISS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.