HomeMy WebLinkAboutSEP1973-00096-4 3
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903 E. Caroline' OLYMPIC HEALTH DISTRICT it No.Arlw/.
Port Angeles SEWAGE DISPOSAL PERMIT APPLICATION
Submit in Duplicate; Builder
Court House r 7 /
Port Townsend Date? COY/?3
011NER a �v � P ADDRESS / "r �1 d PHONE 3 (-5-- Vi-I��
DIRECTIONS FOR LOCATING SITEK�r-v �k L : `-i
APPLICATIf>N; IS: HE2EBY, MADE TO: INSTALL N�I4-SYSTIIbi"� AIR EXISTING SYSTEM
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YPE OF BUILDING NO. OF BEDROOMS
BASEMENT
SITE SIA
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D:RAINFIELD LENGTHiao' �,IIDTH ° -3,Y " DEPTH#LINES ISEPTIC TANK SIZE 1 ® C�
DRAIr! A DETAILED PLOT PLAN BELOW. SEE INSTRUCTIONS. SOIL TYPE 5 �-� LN -N
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ANY CHANGE IN BUILDING OR SE':AGE DISPOSAL PLANS, LOCATION OR SITE, INVALIDATES iS
PERMIT UNLESS PRIOR APPROVAL OBTAINED FROM THE HEALTH DEPARTMENT.
D OF INSTALLATION 3oh3 SIGNATURE OF APPLICANT: 1
APPROVED DATE �7 INSPECTED BY DATES 3
SANITARIAN'S C011MENTS:p
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I CERTIFY THAT THIS S Inz IN THE MANNER APPROVED BY THE
HEALTH DEAPRTMENT
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