Laserfiche WebLink
; <br /> , �" SNOI�UMISH HEALTH DISTRICT <br /> Environmentsl X�elth Divisian <br /> Courthouae, Everatt, v'athington 98201 <br /> APPLICATION FOR A SEWAGE DISnOSkL SY'STEM PERMIT <br /> I S�ibmit 3 copiesl , <br /> \cct.�r. --- -'��,�_024-0204 <br /> Pcrmii lo bc itisued to . . . <br /> g�,-.�� ��„�z_ <br /> Fur installa�ion ,i� lstrcet address) __� . � � <br /> Scc_1'��p.--Rg.—Short Plat No._Lot_Plat — Lot_Blk._ <br /> T�'pe of 6uilding: Ne�c--Ezisting—Single family tesidence No. bedrooms � , <br /> �V:�trr Supply: PuUlic__ Pricate Other. (specif)• t��pe or use) .. <br /> Buildcr <br /> Addrcss _ Tclephone 3`�S—�Roo <br /> • nddress �-iccnse No. .�OT49 ' <br /> Dc�igncr , , <br /> Suil Log Hnic No. 1 __ <br /> $uil Lug Holc No. 2 _ ' - <br /> f:. ; <br /> I:Ic��ation o(\1':ncr '1':.blc, il cncountcrcd. lDis�ancc from ground sur(accl � � -.;�+ <br /> Ccrrcctions to control surPacc e�atcr if nccded ..'�,•'� <br /> ,,�n <br /> b �I <br /> Fill nccdcd: IAtnounQ _ � , <br /> Perculation: Z� �.,<-gr:��. <br /> Tc+i I{ole \o. I A��erage Rale __IF�II in miniinch-bouom b" tcst holel Depth tetit taken I <br /> 'f.tit Ilule No. 2 Accrage Ratc-- —IFall in minlinch-6ouum 6" �e.t holc) Deplh tcst taken ._ ��Q.--�� . <br /> l-cst I�lolc No. 3 A��cragc Ratc _IFall in min;indt�buttotn b" tcst holc) Dcp�h tcst taken .. ., <br /> ,\verage percolation rate on �chich tu U�s_ drainticld design----------Date taken �f tlTlP 15. 19� p;. <br /> ti�p�ic t:mk rcyuircments bascd on prc,cw rulcs and regulatiom: � <br /> � <br /> Septic Ta�k Size— ----Rallons. � <br /> ,lmount u(Syuarc Fccc of Di•;posal Ficld _"I�r. �ti'idth Tr. Depth �� <br /> Datc �'�nP �4� ] 077 �'' <br /> tii�uawrc of Dctii�;ncr � � �. � � . <br /> DO NOT �VKITE I3ELOW 7'H1S LiNL- lto be completed bc issuing agcncyl ". <br /> » <br /> � <br /> No Pcrmit_vatc Sanitarian Pcnding . <br /> Pcrmit to bc iswcd Datc .--Saniuvian ----- � — <br /> R��nc�cAcd_ Sanitarian 1Yci Wintcr Nlonths — . <br /> Chcck Nccciccd Cash Recci��cd Pcrmil l2cncu�al <br /> C'allcd Ibr Inspcctiun mstallcr — — <br /> � -� ' � _._ Pcrinit Numi.cr __ �� t � �� I <br /> 1 crmit isaucd ldalcl.�— - -- � <br /> �' <br /> �. . <br />