1963, 08-23 Permit: 19514 Sewage Disposal)NE COUNTY HEALTH DEPARTMENT
PERMIT NO. / 9k 2 /
E. 0. PLOEGER., M.D., Director of Health
Division of Sanitation
N. 819 Jefferson
Spokane 1, Washington
DATE
N9 19514
APPLICATION FOR PE IT T • STALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
_Address. 620 75--1 ID_ ..Phone AO s
of Property --
basement for building planned?..
Camp Capacity Other.
Address of Proposed Site- -.444/4
Type of Use —Z21e0-1.111—e)
Water Supply,g . . . City, Well, Spring).
Number of Bedroo Capacity
Septic tank capacity
Length of disposaffield.
e.Pd -Leaching Bed--
.gals.- ' StYle$f tarik__Z...»...--__.,_.-...,
, •
--:.—Dist.„Box—___
e
th 2
...
ti -xi..r...f
Ilvesc.'',
(1). Draw===4=ILL area to scale.
(2) Show relatiVe location of: Proposed house, septic tank,
2
41,10,.. kid°
disposal field, well, garage, and other out buildings. ki2e.
(3) Make note of any heavy slope or swampy area or any
other important topographic details.
ta 11
SPINA* C611111 10.
N
-its-I
citichg
1. To ftsekr::
toc,Qre Co 491' pgirt
7./.1.04-0 uR4
67"6-
,•6•11.•
Final Inspection Date. /4/
Remarks:
C ALJ
CONTRACT°
(Form 346 - Rev. Health - 5M .9/58)
.....•••••••••10..
.0C./2werdr-&—BE COMMENDED PERMIT BE
By
Sanitarian
••••••••iVi
,„..
ry I_Ittfele- e /wort Cf cJ