1969, 12-22 Permit: A05519 Sewage Disposal-SPOKANE COUNTY HEALTH DEPARTMENT
PERMIT NO.
E.O.PLOEGER,M.D.,M.P.H., Health Officer
Division of Sanitation •
N. 810 Jefferson Street
Spokane, Washington 99201 DATE /,2 - a —6/9
N® A05519
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
Name Ct yP a,t- p
Address of Prop sed Site t ,2'�
Il
Address VJCVL g. ?xiyPhone No &$ v-(727/
Type of Use —j(.c)2 Is basement for building planned.) t-h,Q--
r/
Holding Capacity Camp Capacity Other
Water Supply (City; Well, Spring). Drywell 710
gals Style of tank
Absorption Pits
Number of Bedrooms
Cl l C(
Septic tank capacity / G ()
Length of disposal field //677
ihach Bed
(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 area or any
other important topographic details.
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Installer•
C.-� e
Final Inspection Date
Remarks. /
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CONTRACTOR
rose 346 P[V. HCALTM
For Spokane County Health Department