HomeMy WebLinkAboutSWG Onsite Survey - 5/10/1998 47
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�LteQ N)" ON-SITE SEWAGE SYSTEM SURVEY
LOWER HOOD CANAL CLEAN WATER DISTRICT
® Project: LHC 7I t�� a 6 Area: # 10 ToLk, yo- Date:
OWNER INFORMATION
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MARGUERITE M TVETEN EST Owner's Phone: o - .175
10002 BRIDGPORT WAY � _ 1 (£g9ene &LfenD
TACOMA WA 98499
32220-50-02008 ry
SITE INFORMATION : .�Qh/4t lyaHG5 and R. V /5 /p/o/J,CES R. V. S
Parcel # : 50 - DZ�oo? Well Depth:
Address: LIF 1101 /0 .U6R'0151104TN/)City: Z190V I State: WA Zi : ?8,5 .
Building Type: S (F-Fuu Time Residence; S -seasonal; C -Comrnemial; M - Multi-6milY; V - Va AM )
Septic System Type: S (S - Standard tent and drainfield; P - Pre wore DiAnbution; F - sane nit, ; M -
Moum; T - Deep Trench; H - out Houae; O -other; U u )
Installation Date: / 23 Year Last Pumped: U (emer Year«U - u )
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System Location: (F-From Yard; B - Hack Y.rd; $ -side Yard; A - Adjacent face; U - unknown)
F�,/NHEAO �—
Number of Residents: co rn menu Shoreline (<loo feea Fiom M.r;ne a Preah water) (Y/N)
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OCCUPANT INFORMATION(complete oply if different than owner):
Occupant's Title: (MR, MRs, Ms) First Name: Last Name:
Occupant's Phone:
Would you like Information on Water Conservation? (Y/N)
Would you be interested in a Community Workshop? (Y/N)
PERMISSION FOR ACCESS TO INSPECT THE SEPTIC SYSTEM: . (Y
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SIGNATURE: Ace?is �� � oOL/- / 0a. 0PK Date: 31 176
Comments: I`' p idt?n-1- is Q loeek,-eh �c�f rcu d f C 4r
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Revised June 29, 1994 /T Coa Id be 111 fo ti/A y Ile Co i-e -they 4//Go/i/dh - a //4 b/e_
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