1959, 10-02 Permit App: 16122 SewageSPOKANE COUNTY HEALTH DEPAR 1 MEN 1
PERMIT NO I (1.1. 1
E. O. PLOEGEf, M.D., Director of Health
Dlvisloa of Sanitation
N. 819 Jefferson
Spokane 1, Washington
DATE
- L/7
N9 16169
APPI. AT ON ICOR PERMIT TO INSTALL GR RECONST CT SEWAGE SPOSAL FACILITIES
dre c7c O .Phone No
Name...
Address of
Type of Use ..12r$7..../ - ....1s basement for building planned?....:-...—.,.
....w. ..8 lid ape ty Camp Capacity Other
,.... ell, Sp�fitg.,.....,Del•
Septic tank capacity.,,_ .... _.,.~_:��.... ............... _..gals. Style of tank
h of disposal field....._.. ..... .
...._Size of Property
act/....3
Number of Bed
Water Supply.
(1) Draw In property area to scale.
Leaching Bed Dist. Box
(2) Show relative location of: Proposed house, septic tank,
disposal field, well, garage, and other out buildings.
(3) Make note of any heavy elope or swampy area or any
other important topographic details. 0
WIN
Final Inspection
Remarks -
CONTRACTOR L{Al
(Form 316 - Rev. Health - 5M - 0155)
Tod ZOO#
RECOMMENDED PERMIT BE
By ,r
Sanitarian
OAS Hr1d3H:QI LT:TT M. -TO -EGA