HomeMy WebLinkAboutSWG Inactive SITE NO. / a ® FOR DEPARTMEWT USE,ONLY
MASON COUNTY HEALTH DEPARTMENT RECEIPT
ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMOUNT NUMBER
428 WEST BIRCH STREET • SHELTON, WA. 98584
PHONE (206) 426-5561
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BY:
PROPERTY OWNER
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SEWAGE SEWAGE: ❑ APPROVED ❑ APPROVED
SEWAGE y� DESIGNER
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BY:
LEGAL DESCRI TION ^�r
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NO. OF LOT PERC. RATE-
TYPE
OF ,�@,�?�orr L°�cety BEDROOMS SIZE X DEPTH TO WATER TABLE
BUILDING v GAL. PUMP REQ.
SINGLE FAMILY E?r- PUBLIC WATER ❑ NAME SEPTIC TANK(S)
WATER SYSTEM SYSTEM FEET
COMMERCIAL ONLY DISTRIBUTION TILE TOTAL
LIQUID WASTE G.P.D. SQ. FEET
FILTRATION AREA
DIRECTIONS TO SITE: QUANTITY OF CU. YD.
APPROVED STONE-
FILL YD. SAND---
FILL REQUIRED CU. YDS.
FINAL INSPECTION REQUIRED BEFORE BACKFILLING
F�DEPTH OF
BACKFILL
Ci 2"STRAW OR PAPER
STONE
O OVER TILE
PIPE SIZE
<- �STONE
UNDER TILE
SITE PLAN AND SPECIAL STIPULATIONS IcRoss SECTION OF TRENCH I
(INDICATE DIRECTION OF DRAINAGE)
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COMMENTS:
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