1974, 03-12 Permit: A13222 Sewer 08/25/2003 15:31 5093241567 SRHD EHS PAGE 01
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SPOKANE ;COUNTY IIEA'LT•HDISTRICT
f E. O. .PLOEGER,`M. D., M.P.H.,.H ALTH OFFICER... •
. . 'N. 819 Jefferson'Street .
•
. Spokane, Washington 99201 . ' .
BATE -I
PERMIT NO. 4 , wa-- No. A . 549
• APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
Namez!/_117.a—e1 . PAddress'ff `S 1 ""t
� -Cd.,-,4`rhone No.t e/ —VD" O
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Address of Proposed Site 17 — 7ul1y &L . • .
Type of Use 7)/0-ez4
Q ,`-p Is basement for building planned? —0(..r�
Number of Bedrooms e0 Building Capacity Camp Capacity Other — •
Water Supply C f . 9 (City, Well, Spring). Drywell `
Septic tank capacity 7.'O gals:' Style`of tank
Length of diiposal field AZ-6 Absorption Pits Leach Bed
(117Show relatlre Ideation of, Proposed house, milt link, ' • • ' ' . l
dli0asal rleld, well, gawp end other out bulldlnat. '
1Z) Make new of any hem slope or swampy ano`soy . •
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other ImportantuPoarophtc 4101.411.0. .. Y
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LOCATION OF - �" "1'' — • I
TltE. Tt{E,.oanwt a ��, �f • •
SYSTEM REPRESENTED BY
tS .NOT TO .5E CONSTRUE SY.YA r I J , . i-
EXACt LOCATION OF .TN • • l 1 •
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• Installer ' ' /• /� • b' �'.. . -."
Final inspection Date -�.� ,, i`�° w .;I''::,. ? :.
.Remarks; -
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C TRACTOR
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FOR 7a •0 V, HEPLTN �� •• For Spokane County Health District
AUG 22 2003 15:33 5093241567 PAGE.01