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�.-- <br /> NiIT TO INSYALL AN ON-SITE <br /> WAGE DISPOSAL SYSTEM �pn <o� , �6 <br /> nvironmental Health – Snahomish Health District <br /> istration Building, Courthouse, Everett, W2shington <br /> "Acct Na ��� `7�S -� '� -Q� Permit No. �� - �� <br /> Septic Tank /OOd gais, � /A.p�'A�� /`71,;/ TL— Waste <br /> Disp, Field�� sq. f4 ����'� ST. �i O.0 o TT-- �, <br /> Trench: Dep�_Width�� ��P c% ,/�LA <br /> �ate /-6 - �6 <br /> PERMIT EXPIRES ONE YEAR FROM DATE QF ISSUE <br /> Sanitation Office – 25�-9473 — <br /> DO NUT COVER SYSTEM BEFORE FINALLY APPROVED BY SANITARIAN = <br /> �W'Y'�ft:+n.'N,iHr.1�Y�S'�'�N �ti"(i1.K�.r�—r. .. 't. f �.�.�.. _... _... . . ... .. . . . <br /> Finel Approval Oisapproved Oate By <br /> flemerks <br /> Senitarian Date <br /> � <br /> ��� xo-zo <br /> ......�, .,. ....... ........�.o,o.a��w .�....-s,...��,., ���.,.�or - . <br /> Fiti needed: (Depth & Amount) <br /> Percolation Tes[: (Fall in min/inch-6ottom 6" of test hole) <br /> Test Hole No. 1 Average Rate Dep[h tes[ taken Tes[ Hole No. 3 Depth test takcn <br /> Test H�.le No. � Average !<ate_ Depth test taken Tes[ Hole No. 4 Ucpth trst taken <br /> Aver,iKc Percol..:ion Rate �` _ Date T�ken �-Y'S� <br /> Scptic 7'ank Size �f[7v v _ gallons, Sy. I't. : ��O 1'r. Nidth ��/. 'ir. Depth �, a� :. <br /> Signature of Designer �n_,. --:,..,� License Nn. /?/ry� _ Date � ' %�+ •`JC"- <br /> � <br /> DO NOT WRITE BtLOW THIS LINE (to be campleted 6y iuuing agency) <br /> Well Setback Compliance: Ycs_tio_Permit Denied_ Sanitarian <br /> PendinF� (date) <br /> Permit to be issued �'� Da[e ��e � `�- � `' ^r1 �� � .: +�` � <br /> Sanitarian \ ..:� <br /> — c �1� 7�a <br /> Called for Inspection Installer Reinspection <br /> Permit issued (d�te) �- Permit Numher____ Permit Reneu�al <br /> :? � . ( �i ,I, �C_._. <br /> No-i< eev: iaeoimk �' . . .. . t . . <br />