1954, 01-05 Permit: 7944 Reconstruct Sewage-- 4POKANE COUNTY HEALTH DEPARTMENT
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PERMIT NO � — 7 0
Name
Division of Sanitation
N. 819 Jeffer
Spokane 1 W2st ington
1\T° 7944
APPLICATION FOR PERMIT TO INS OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
r
r Address a Sr" A
DATE
�—
Address of Propos stet
Type of Use
e No
Size of Pfoperty - --
Other
Number of Bedrooms Building Capacity Camp Capacity
Other
Is property below grade of streets or alleys? Are streets graded in?
Is basement for }xµ ding planned? 1 i
How much excavation r fill pr�.,sed?
Water Supply 6 1 (/ '
"` �'C ity, Well, Spring). Drywell -..- �y' _-22,-"/ ,,� 1
Septic tank capacity S4'_Qo gals. Style of tank
Length of disposal field-- _- - -..;. Leaching Bed
(1) Draw in property area to scale.
(2) Show relative location of: Proposed house, septic tank,
disposal field, well, garage, and other out buildings.
(3) Make note of any heavy slope or swampy area or any
other important topographic details.
Date when test hole will be ready for
inspection THE LO�A7►pN O! -
REPRES THE
Date installation will be SYSTEM REPRESENTED BYY,N METE SEWAGE
�c OS�tfl h I C� ct R�t1' EG
FACT LOCgTEO gTRUEID AS AN
before backfilling) N OF jHEy'STf/4-'
tF1
SANITARIAN'S REPORT AND RECOMMENDATIONS:
Topography
Ground Water
Date of Inspection ,
Soil Condition
Special Recommendations
Final Inspection Date / 6
Remark--
r
Percolation tests: Minutes
CONTRACTOR
(Form 346— Health- 21/2M -7 -53)
RECOMMENDED PERMIT BE
By
Sanitarian