1986, 08-19 Permit App: 00012718 MH'OKANE COUNTY HEAL -TN -DEPARTMENT --'
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PERMIT NO
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`='rAPPLICATION FOR PERMIT TO
E.O.PLOEGER,M.D.,M,P.H. Health Officer -rt -
.Division of ,Sanitation
N. 810 Jefferson Street
Spokane, Washington' 99201 _. ,T'DATF AD — /S
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Name7.C�b,d�l
Address of Proposed Site
INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
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Type of Use /CLo (LQ o -
Number -of Bedrooms 2"--- iaiilc
Water Supply
Address 5- 37'2-- 01/42-i,.,
Septic tank capacity
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Phone No
Is basement for building planned)
ing Capacity Camp Capacity Other
(City, Well, Spring). Drywell
gals Style of tank
Length of disposal field t4S-0 / Absorption Pits teach Bed
73-V
(1) Show relative location of: Proposed house. septic tank,
disposal field. well. garage and other out buildings.
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'12) Make note of any heavy slope or swampy area or any
1A other important topographic details.
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Eot Spokaon�ep County Health Department
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DEPARTMENTAL REVIEW
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I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
Owner's Signature�`t-4a' —
Date - (9 -
4.
Approved
Cond.
Approval
Hold
Environmental Health Permit Number
1.4
W. 1101 College
Room 200
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Planning/Zoning
1 N. 721 Jefferson
Permit Number
Engineers
N. 811 Jefferson
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Utilities
N.811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/CrItIcal Materlal/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent is true, correct, legal, and binding.
Owner's Signature�`t-4a' —
Date - (9 -
4.