1970, 04-27 Permit: 06005 Sewage«E=
SPOKANE COUNTY HEALTH DISTRICT
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PERMIT NO.
E. O. PLOEGER, M. D., M.P.H., HEALTH OFFICER
N: 819 Jefferson Street
Spokane, Washington 99201 Jj
P DATF_ .. C%—a7 %- 70
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NA 06005
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
Name F^.t AA -C -C Q,/ C141.4�1�
Address of Proposed ite / (6/e-
g.
Type of
Number of
Use
Bedrooms Building Capacity
Supply 1 'L' —1.(City, Well,
Septic tank capacity
Length of disposal fiel
Address (Mal 4r�,Ni 1A one No s—y�i
Water
Ts baseent for`buikding planned,{
Capac .t
y
Spring). Drywell
gals. Style of tEink —
Absorption ljits T.4a(h Bed
9
Otter
(1) Show relative location of: Proposed house. septic tank.
disposal field, well, garage and other out buildings.
(2) Make note of any heavy slope or swampy
other important topographic details.
Installer
cQ
Final Inspection Date
area or any
7 I 7 (-)
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Remarks -
CONTRACTOR
FORM 346 REV.NEALTN
For Spokane County Health District
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