I
•
!io. l/ l ::,["-:J_ <:our.house !lmiex 01;-=:p<_a, _ ·r ngton
5th & Birch Shelton, Vash.ing•"°1? ?hone: �26-!!�07
Di.strict lhur1ton-Mcuon Health
?hone: }52 1 � Date /4.y..z. z t. Phone AL • f - ..A(; S-} t-tJ--J,
HI.ALTH
Of INVIIONMINTAL
DIVISION
SITS A?PLICATIQ'!i 00 Date 'kf- ..2. °"-'ner �.L ll
53WAGE A?PLICATICEi
'2L
Cit,&/ J State
¥.ailing AdcL-ress Builder
-=-2.J:-l. L
Add_ress
I
.Jhe./4 � 6l: t- 7
Se,.-;a;;e Contracto"-1),,,s 0 5 Legal Description L pj
• lJ:,. c-f,t;,.., . e.r,/1Ce Ac:kLr-ess ;;q,.,.&p 171 ,
.P y,, ,{
Lot Size�3S'"X,u
ll :s;''i:'tended use of 3a;i ldjngs 4
ca cl c!
?a.reel Ho.
Di.rections to ?roperty:z;; Cb
I
±a z"d e ,,,. , de S.. c p., L e-fll-. Ho. of Sed.'""""5 .:2..- !io. of 3ai;.;"l...Y"QOC.S Base=e..n.t Water Syst�: PU3L.!.-C ?R:PIA'?B -4- -- DRAW 2EiCE in bl.a.rut space: l. ?ropeM::7 l.ines and location of house on lot and <i.icensions of lot. 2. Location of house and se-..:age disposa.1 syste:J in relation to st.rea::;s, la!ites 1 wells, patios, d.T"l.ve-..ays, underground tanks, .ater supply lines and ease::ents. :;. ?!"Oposed f'i 11 --, including depth, a...-ea, porosity am a::J:R.mt plus location of dra.ins. t- Da!r..Dt?i o-• .O li:..!·OCl!-:1 �Q.+ I � "' S?r.IC T�3 SIZE ·- .. - � � ,s.. /- - �� - - -b.,.. ,., � ,- "<-,, Y. I \I - - --\, , -- i I, '."' � • � ·:x;_ � ' I'- I, " .. � .. ? '- .. � i '-- '- I� I ' I �. .... � The septic sys<= is an approved tecpora. ry aethod of sevage disposal uutrr- 1 - sanitary severs are available. Sn"?; APPLIC:.TIOili f},_ A.?PLIC>..H'i" Is SimiJd.,,.:B: •....�.oy ,... lo •o fee SApitperovi.-e"ldS'j)e.,E{ion _A-� Z , l '11.l 1 Date J :Rte0cteAipptprHoove. d�£ '"),-Y--- By Date -� J � Sam.ta! SEliAG2: Af'?LICA'i'IOill APPLICJJfl' 1 S SlffilArulB 1 / 0 41ev ft;. Lte %; , 0 fi<2 � Receipt !10. /� Y- BJ (LI ?emit Ho. Pt, ( M - ,n 111, . te DAT£ �;(,g C::19 37.�. I n,ar-.an
I I '
I I
Powered by FlippingBook