1990, 12-03 Permit App 90006348 MHU. '3:5050124-
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Spokane County
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3575
INFORMATION WORKSHEET
PARCEL NUMBER: 15 J ! 11 D 2 S -Z l
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STREET ADDRESS: 1= 1,9(2. 6 CCC u e_ CIVG(-2
CITY/STATE/ZIP: GUY-Pa,.arv-e.S L(1G(_ ggt6
SUBDIVISION: La e_ev-v y
BLOCK: 6 LOT: )6 ZONE: DISTRICT:
LOT AREA: I53L J F/A: WIDTH: GI0 DEPTH: 650 R/W:
# OF BUILDINGS:D2 # OF DWELLINGS: WATER DISTRICT: . (o (A 5r)I LGQ (C r
r (eve Gv/ P e (O u LAff(lii PHONE: - i
MAILING ADDRESS:
CITY/STATE/ZIP:
CONTACT:
PRONE:
SETBACKS: - FRONT: (0 LEFT: YS RI(jl'1: 6 REAR: 60
PERMIT USE:
L to qoLA, Q
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER: -nit v:cf--(
CONTRACTOR: bt \ ! (o (.P , (D(^,,espuoNE: - 5351 Z-gcy /
MAILING ADDRESS: F iD i1 S �, _ _
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: �. REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS:
OCCUPANT LOAD: % BUILDING HGT: /
_ STORIES:
BUILDING DIMENSIONS: Z ( g S 16 (WIDTH % DEPTH) SQ. FT.:
REQUIRED PARKING:
€ HANDICAP: SPRINKLERED:
CRITICAL MATERIAL:
S-POKANE COUNTY HEALTH DEPARTMENT
E.O.PLOEGER,M.D., M.P.H., Health Officer
Division of Sanitation
N. 810 Jefferson Street
Spokane, Washington 99201
PERMIT NO.
No A04052
APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
Name .*&C-1`_t j.L/ /Address
�
Address of Proposed Site
Phone No
r /9,-a-6, (b.ez,,Le_1 (an.c.--,CJ
Type of Use /2�AcL�' Ts baseme f,r building planned)
Number of Bedrooms ilding Capacity f ' 1 +opacity Other
Water Supply �7 1City, Well, ling Drywell
Septic tank capacity 7 ° v Style of tank
sorption Pits • irach Bed
Length of disposal field______41
72
!i
- (1) Show relative location of: Proposed house.
disposal field"well, garage -and other out buildings.
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(2) Make nosos¢ e 6fa}5'yteavy. slope' a: swampy area or any
other imporetyaiy op. raphic details. - ( i
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Installe
1
30
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1 S
Final Inspection Date
Remarks- -
CONTRACTOR •
FORM 3/6 RtV.HCALTX
For Spokane County Health Department
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