HomeMy WebLinkAboutSWG Application - 4/18/1969 611ner1co< arm
/ 8'8' OT/75
Thurston-Mason Health District " ..... ...........nex
Sth & Birch Court House Annex
Shelton, Washington , DIVISION OF SANITATION Olympia, Washington
Phone: 426-4407 � llC6�f0Ii / . B[ Sd8 ,9"4PS0" Phone: 3 -4851
(Submit in Quadruplicate)
DO NOT WRITE IN HEAVY OUTLINED SECTIONS .p�k f
eT/ 60 ;n ii✓e GA aoc rv..........................................................piSNF� y?.6.".6. .ys.y.V
Owner /...............t=...:.............. Phone ... . . ...�
po aov...L.`/.5.7....................... City ..otY P.'.°--------- - ... State ..u%..1N 6�oN
Marling Address .�....:........ ' ' ' ' '""""'
Builder ........................................................................ Address .................................... ............... ................
Sewage Contractor .... Address .............
/7_r— / LqC� Zl: -..�/tic
JLegal Description ........... .................... ./...:..'>`................................................. . ........... .................
.............................................................................................................................................................. .............
Parcel No. Field Book No. ........................................ .................
Directions to Property .....EoRvek co-u.N'..........R.°A............��s.... !!...... ...a... .!�0•o.e....
........./.!J.E........... �.;f........ ....�.7ti............. .. C-.........MC�R /..,........�. I/I....................y.... .................
Intended uses of Buildings . -.......... Public Sewer ........ Water Supply 3 <'P. !.... 8 y to kE I a urn
No. of Bedrooms.....3......... No. of Bathrooms------I--------- Basement ------- Septic Tan -l.1.00...G A 4�0,4
Typeof Soil ........................................................................................................ Lot Size ..6...ACR. F.......
Soil Drainage: Good........r ........... Moderate Poor... None........ ......----------
DRAW SKETCH in blank space or on separate sheet indicating the following:
1. Property lines and location of house on lot and indicate minimum and maximum set acks plus
dimensions of lot and all buildings.
2. Location of house and sewage disposal system in relation to streams, lakes, we Is, patios,
driveways, underground tanks, water supply lines and easements.
3. Location of all interception drains or french drains.
4. Proposed fill, including depth, area, porosity and amount.
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APPLICANT'S SIGNATURE ...... c�-rr>....... . .. ....... DATE . ... . :...l.B.. .(..P.Ff
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Site inspection fee "Receipt No. '.y ..... By/ -.- .�.
\ Approved .y'I .'(�.Pj Not Approved .................... By ... .. .? !s.[<:........... ...................
DATE DATE SANITARIAN.