1968, 04-16 Permit: A03341 Sewage DisposalMAY -13-1997 14:35•
P.02
SPOKANE COUNTY H.EALTi-9 DEPAK 1 MEI! 1
E.O.PLOEGER,M.D.,M.P.H., Health Officer
- Division of Sanitation / /1�
N. 810 Jefferson Street sr!! j / — / y
Spokane, Was
on 99201�•f DATF 4 - FJ di
Nm A 03341
'PERMIT NO
Name
4
APPLICATION FOR PERMIT TO INSTALL 0
CONSTRUCT SEWAGE DISPOSAL FACILITIES'
.744-rKit- �h , Address21.±17"/144d11-4L-Ci
.I,I�1 S^"'4" '-�i Phone Nd a 4 133
It
Address of Proposed Site
Type of Us
Number of Bedrooms
Water Suppl
Septic tank capacity
Length of disposal field 20 O Absorption'Pits
.L
Is basement for building planned?_
ilding Capacity • Camp Capacity other
(City, Well, Spring). Drywell� '
/A 0.0 gals. Style of tank_
tic tank,
(1) Shoo dispoeay.�Eield. well,ive garage and other out buildings.posed house,
(2)7ilskgg,,.t e�tta o[ any heavy lope .or !swampy area'or any
£n0 o�rtant topographic details.
t s nt : c, O
cce:,'.
V
a i`v
{�v.;m
R
qb
2
Installer
Final Inspection Date
Remarks-
Sf
it
v
St
Aa',
ach Bed
Yfiec , dr.?: sce •
For Spokane County Health Department
TOTAL P.02