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1955, 01-04 Permit 9495 Sewage Disposal_SPOKANE COUNTY HEALTH DEPARTMENT Division of Sanitation - DATE '/ V ` \ ' N. 819 Jefferson Spokane 1, Washington 4LPPLICATION FOR PERMIT • INSTALL 0 R • ONSTRUCT SEWA DISPOSAL FACILITIES Address V 71/O Addressof Proposed Site Type of Use^ Number of Bedroom wading Capacity VCamp Capacity . Other Is property below grade of streets or alleyeys?r Art streets graded in' - Is basement for buil g planned — How much excavation or fill proposed' Water Supply (__ .._ / City, Well, Spring)... Drywell j Septic tank capacity �lgals. Style of .� Length of disposal field___9( 49 d .I-R�+.Q' '-— Leaching sad-- (1) Draw in property area to scale.__.: (2) Show relative location of: Proposed house, septic tank, disposal field, well, garage, and other out buildings:--- (3) Make note of any heavy slope or 'swampy area or any other important topographic detailc Date when test hole will be ready for inspection Date installation will be ready for final inspection (that is, before backfilt;ng).. SANITARIAN'S REPORT AND RECOMMENDATIONS: Date of Inspection Topography Ground Water Soil Condition - . Percolation tests' Mmutes Special Recommendations.:., . .: (berm sae..a'atm- 2341u-7-ss).s.: 1