HomeMy WebLinkAboutSEP1974-00263`/?,a err J
903 East Caroline
Port Angeles
OLYMPIC HEALTH DISTRICT Court House
Port Towusend
BUILDING SITE INSPECTION APPLICATION n
Submit in Du plicate 6 �`"t
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OWNER� ADDRESS DATE���5,�
LEGAL DESCRIPTION ! C -'~ 'e�cr
DIRECTIONS FOR LOCATING SITE M& \ems
AN APPLICATION IS HEREBY MADE FOR APPROVAL OF THE ABOVE LOCATION FOR A
STRUCTURE WHICH WILL BE SERVED BY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
RESIDENCE COMMERCIAL BUILDING OTHER
2
NO. BEDROOMS BASEMENT.w.rr,..r.rr SITE SIZE to12g -� SOURCE OF WATER
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TYPE OF S01I4 5 A--�a TO WATER TABLE
DRAW A SKETCH in the space below* indicating location of building in relation
to other buildings, property lines, well, streams or other bodies of water.
Indicate proposed location of sewage disposal system.
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* See reverse side for remarks.
THIS IS NOT AN APPLICATION FOR A SEWAGE DISPOSAL PERMIT. A SEPARATE PERMIT IS
NECESSARY PRIOR TO THE INSTALLATION OF A SEPTIC TANK AND DRAINFIELD.
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