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rlTY OF PORT TOWNSEND SIDE SEWER AS -BUILT PERMIT NO. Ls
OWNER �'� ��,u� Site Address: a5o� ��'� Contractor:����
)ate Permit Issued:
Inspected By:
Z1 -
1. Commercial or Domestic
2. Distance from property line to sewer main
3. Distance from house building line to property line
4 Minimum grade from main to property line
5. Distance from M.H. No. to Wye
6. Depth of sewer main at Wye
F2DATA\FQRMS\sidesewer.asbuilt.frm.doc
Joint
Inspector
7
8
9
Date.
Depth of pipe at house connection
Type of Pipe
Remarks
Size of Pipe