HomeMy WebLinkAboutWEC95-0236 - WEC Application - 9/5/1995 MASON COUNTY DEPARTMENT OF HEALTH SERVICES
POST OPFXv BOX 1"6
SHEUM* �
)WA 9
WELL CONSTRUCTION PERMIT- I A Q
Receipt No: - SEP 0 5 1M
Date of Payment:
INSTRUCTIONS JPAI_ HERVI(;i.
t. Coeetete Pert One.
2. Pay 160 fee and subait this application a minimma of 24 hours in advance of initiating construction. Male thee}
payable to: Mason County Treasurer
3. Attach plot pion.
4. 24 hours prior to dri tl ing the well, contact the heel th dove rtw t and provide start-card saber using one of the
following methods: Fes to: 427-7798, or Telephone: 4Z7-9670 ext. 35Z (8t00 a.a.-StOO p.a.)
PART is APPLICANT/PARCEL IDENTIFICATION
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SITE HOUSE ADDRESS E 560 Catfish Lake Road
DRILLING FIRM NAME Arcadia Drilling Inc START CARD NO. W067771
PROPERTY OWNER NAME Harold Hatfield TgLgpgONg (360 )898-6700
tyf MAILING ADDRESS PO Box 400 Union , WA 98592
;t ASSESSOR'S PARCEL NUMBER 3 2 1 3 4 _ 7 5 _ 0 1 7
t SUBDIVISION (If Applicable)
¢i DIV _ BLK LOT
r DIRECTIONS FOR LOCATING SITE SF• I /4 NW 1 /4 S-34 T-21N R-3W
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DATE OF ANTICIPATED INITIATION OF WORK: 09-07-95
DATE OF ANTICIPATED COMPLETION OF WORK. 09-07-95
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PART 2: DEPARTMENTAL USE ONLY
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