1954, 09-20 Permit: 9005 Sewer f` SPO
TEL kk ff 945E2247', }} 1
_1 -'c.i Fri_, 7F--, ..I'D:HEALTH �..Y..._ TC� I'i��: +i_2;= F-_� __.��.
CPOI<ANE COUNTY HEALTH DEPARTMENT
.- '•' , Division en sf Sanitation
_ . vis $1 on DATE - a 0 '•• tl.
s 9 Jefferson
g' 4 Spokane 1, Wash;ng+on L.L. 0
PERMIT NO litf' - ; 7 N4 9005
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE C1i5POSAL FACILITIES
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daresfi / , '
Name. I`i.
.41
. 4-�'-- Phone No 'x- 17"
..- 0 . I / 7
Address of Proposed 0 < 0 Z 7 _ . J"r.�
.,..,. >......._..._............._ ,., ..--•- � —,size of PropertyX 1
Type of Use w�f-Otterr ,.."---�
Number of Bedrooms Building Capacity...,.._.- Camp Capacity Other
Is property below grade of streets or alleys? .....................Are streets graded in?
Is basement for �sil
din3 p� • How much excavation .r fill proposed?
Water Supply
4
d/.---
y, Well, Spring). Lrywell._
Septic tank capacity___„ ... StyleL- `-
Length of disposal field 1 A ......-_..._ .......... Leaching Bed . /
(1) Draw in property area to stale.
t
(2) Show relative lettetian of: Proposed house, septic tank,
disposal field, well, garage, and other out buildings.
s./
(3) Make note of any heavy slope or swampy area or any
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other important topographic detain, r' ,
Date when test,-hole Soli„ e're ,y;€ar ':' `'
IN
ar (;i _inspection ,. , > it - OC. -
r:
Date installation will be ready for final inspection (that is,
before backfilling)
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SANITARIAN"S REPORT AND RECOMMENDATIONS: Date of Inspection
Topography_
Ground Water
Sell Condition Percolation tests: Minutes
••
Special Recommendations
•
Final Inspection Date„ CIL Y` - / f,,'..4... s ? tea. .i~: •. :