1964, 11-20 Permit App: A00327 Sewage Disposal . SPOKANE . COUNTY HEALTH DEPARTMENT
iE.O.PLOEGER,NI.D. ,M.P.H. , Health Officer
r Di- ;ion W Sanitation
N. 810 Jefferson Street /9-`:
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Spokane, Washington 99201 DATF j'/ /6") (1
4.
PERMIT NO.
No A 0 0 3 2
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
Name 14,4, /'. ''''ds-61-*---("--4" —i'6""2--'Address t S e h•Phone No:24 4--12i
Address of Proposed Site Y:, . / . 1- ) (Z t'4
Type of Use d"` "tj--Z--= --tom _i Is basement for building planned) J' ._"_____--
Number of Bedrooms Eklilding Capacity Camp Capacity Other
Water Supply ' / -4-- - C✓L-L- ../. Cit
( Y> Well, Spring).rin g). Drywell
P4:17.:'
Septic tank capacity ejid.egals. Style of tank
Length of disposal field / v'
Absorption Pits '--- Leach Bed \"T`
(1) Show relative location of: Proposed house, septic tank,' _ ' ------41 ?-ii ,(
disposal field, well, garage and other out buildings. Cj, `a�
(2) Make note of any heavy slope or swampy area or any -' s
other important topographic details. k•- r',
VP
"g') (1/4 — f/15--4 1
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THE LOCATION OF THE ON-SITE SEWAGE/ �( of �q' (jf"Tt
SYSTEM REPRESENTED BY THE DRAWING /41 l
IS NOT TO BE CONSTRUED AS AN ‘,0,' i' 6 r I y. / 'PI
EXACT LOCATION OF THE SYSTEM ------ ';
615 hit" •
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Installer s' r1-'»+—%v,�/ Y
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Final Inspection Date '4/ -- 'C '" S (A)- J:- .- --'124=.e,-46.--
-' -r.e. -46.'"' -,
Remarks: .. -.7- -- % — _ ( /'i- .._1+'.'' r' t. V /,
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CONTRACTOR '- l ,k di ;
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FORM 346 REV.HEALTX For Spokane County Health Department - ',
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