1974, 03-18 Permit App: A13265 Sewage DisposalSPOKANE COUNTY HEALTH DISTRICT
E. O. PLOEGER, M. D., M.P.H., HEALTH OFFICER
N. 819 Jefferson Street
Spokane, Washington 99201
PERMIT NO / 3 : 2 6 5
Name
Address
Type of Use
Number
No. A 13588
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
Address�2 Phone No
of Proposed Site 2 7• 7 :9-O / — li-5-76 21 6 S74s
7'9' —S�� U/
Is basement for building planned?
of Bedrooms Building Capacity Camp Capacity Other
✓ (City, Well, Spring). Drywell
Water Supply
Septic tank capacity
Length of disposal field
73-0 (% C 6 ° gals. Style of tank ,)
,.41"/
(1) Show relative location of: Proposed house, septic lank,
disposal field, well, garage and other out buildings.
(2) Make • o any heavy slope ampy area or any
r Important topographic details.
Installer
AbsorptThn
Final Inspection Date
Leach Bed
St-A 1 7 y A
CONTRACTOR
1
1k., FORM 346 REV. HEALTH
For Spokane County Health District
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