Report WASHINGTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL HEALTH AND SANITATION
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AUTHORIZATION NOTICE REPORT l 5
CR #.: 1 4 rsos s Date(s) of inspection: < (ZS(t o
Date Rec'd: 4,/17( to
r l AUTHORIZATION NOTICE REPORT
1 1 MEMORANDUM
Map and Tax lot number: Township 25 Range ( Section _ 9 (AA T.L. #. goo
Road Name: 14335 ` 5y4 I ZS g OE J 'Tf(Pt2n
Property Owner: ,4PetL, OELKE G fo Coe, t-ttimPOte
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APPROVED
This notice authorizes the use of the on -site sewage disposal system located on the property identified
above to serve a
with a sewage flow up to gallons per day.
7<. DENIED
If Authorization Notice is denied, it may be reviewed by the Department of Environmental Quality
upon request. An application must be submitted for review within 30 days. A denial review fee is
charged.
COMMENTS /CONDITIONS: / ge,P7SRz 65 7' gee.ACE ' 157r J 3 - 6ED2oa.
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SANITARIAN: DATE: Lam_ (ZS( Io
F:\Authorization Notice Report do !.- -98, r . 08/10/ 004