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903 E. Carolix%e OtYMPIC HEALTH DISTRICT
Port Ange`I s SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate
Court House �`;■�..,
Port Townsend
Permit Noe 5&_ds
Builder ,
Date ?
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DIRECTIONS FOR LOCATING SITE
V-1/1-1 0,
APPLICATION IS H 2EBY MADE TO: INSTALL NE l SYSTEM &REPAIR EXISTING SYSTEM
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O, ,OF B' DROOMS PAS TENT SITE S
3_,'M
INSTALLER
DRAINFIELD LENGTH �" i,.jSDTHDEFTHS SEPTIC TANK SIZE
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DRAV A DETAILED. PLOT_ PLAN BELOV!,SEE INSTRUCTION: SOIL TYPE ,
aUY CHANGE —LN BUILDING OR SE SAGE DISPOSAL PIANS, -= CATION CATION OR SI ,NVALIDATES TIS
PERMIT UNLESS PRIOR APPROV" L OBTAINED FROM? THE HEALTH DEPARTMUTT,
DOF STALLATION S IGNATU4F OF APPLICANT t
APP DATE 4/A % INSPECTED BY
{L CZE DATE
SANITARIAN'S C012illiTS : ._■yinebm
IrCLRTIFY TT?fiT THIS M fA IFS LLED IN THE MANNER APPROVED BY THE
HEALTH DEAPRTMENT DATE a
ST �LLERS NAIKE9