1974, 05-21 Permit: A14021 Sewer f
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SPOKANE COUNTY HEALTH DISTRICT
E. 0. PLOEGER, M. D., M.P.H., HEALTH
OFFICER
N. 819 Jefferson Street
Spokane, Washington 99201
DATE -57/7</
PERMIT NO. /4 /--) .7—?
No.
A
14021
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
Name LP,of 06E0_0_0- Address S/.-) .s, ,6.4...cii
r�„_'( R
hone No. ��C'.-'��3
Address of Proposed Site /7<7° — .-/---e2 -
Type of Use 7"/•—(i
Is basement for building planned?
Number of, Bedrooms. Building Capacity --
Camp Capacity Other
Water Supply C / D _
(City, Well, Spring). Drywell
Septic tank capacity 70'7 O
gals. Style of tank _
Length of disposal field / w
Absorption Pits Leach 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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1111
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Installer /
C J ' �1
Final Inspection Date (O "ligThiligli�� .,�i
Remarks:
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CONTRACTOR ' ''c_..Q�r .
RM 346 REV. HEALTH . . !
For Spokane County Health District