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1974, 03-12 Permit: A13222 Sewer 08/25/2003 15:31 5093241567 SRHD EHS PAGE 01 A '!, a ,1,, ;:•Ti'�.i. rt ;,.,": • �;, m 1,:yf v at� �C �,�MOt' I t... - a k .(.:F 11r r 1n �` a r i a'ft k't' Ml'i p ' ) r 4 c �.� • h6'1 LM_ }MF � ��, f,' t�;fi ":5 t`' ey-�>, Y�' r ta'ax n , '-� r ' , . . 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 Po 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 . • �A. other ImportantuPoarophtc 4101.411.0. .. Y .. 1- {' • tHE 01+l- 1T . 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 • ...r.- • ry4 •T • • r3 • Installer ' ' /• /� • b' �'.. . -." Final inspection Date -�.� ,, i`�° w .;I''::,. ? :. .Remarks; - . . • l • • C TRACTOR ' ''' '01 ‘)': 4' . ; . ' . ' .' s - • .. • FOR 7a •0 V, HEPLTN �� •• For Spokane County Health District AUG 22 2003 15:33 5093241567 PAGE.01