HomeMy WebLinkAboutSewage System - SWG Inactive - 4/5/1991 SEWAGE SYSTEM PERMIT APPLICATION qD Permit Expires
MASON COUNTY DEPARTMENT OF GENERAL SERVICES FOR DEPARTMENT '
NLY
ENVIRONMENTAL HEALTH DATE BASIS FOR FEE AMOUNT RECEIPT#
303 NORTH 4TH I P.O. BOX 1861 SHELTON, WA 98584 4_5 ( �'C 1Dr- (aCJ
PHONE(206)426-5561 W2
APPu T C SITE: Approved ❑ t Approved
ADDRn3C PHONE BY: Y
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q �3-.� DESIG TEM REQUIRED
PRO R �fL/L-' W �iJQ
PRO EBTY OW ER INSTALLATION: ❑Approved [I Not Approved
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ADD SS E
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CI IP DEPTH TO WATER TABL
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sewncE CONTRACTOR f n sewncE SOILTY E:
y ✓��y i NER j
LEGAL DESCRIPTI06 C _ <� /��! �-> /
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TYPE OF NO. OF LOT
BUILDING .e- BEDROOMS SIZE X r /
SINGLE RESIDENCE PUBLIC WATER ® NAME----6 W C.l�
WATER SYSTEM SYSTEM
COMMERCIAL ONLY SEPTIC TANK IS) GAL. PUMP REQ.
LIQUID WASTE G.P.D. - -- FEET
DISTRIBUTION TILE TOTAL
DIRECTIONS TO SITE: Cf;( h"', r �,
r- 0 oa, Hw 3 L.' t k - S t'.< /a `f1 lf! ILTRATION AREA TOTAL SQUARE FEET
Pl(`�(e.!'I� �, FINAL INSPECTION REQUIRED BEFORE BACKFILLING
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OR PAPER
LG1L-� VNw N�P STONE
PIPE SIZE
STONE
SITE PLAN AND SPECIAL STIPULATIONS �� _� ( UNDDEERR TILEA
(INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH
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OFFICE
SEWAGE SYST`EM PERMit'A$P!' F,' �l s No. Permit Expires ( 1
MASON COUNTY DEPARTMENT OF GENERAL SERVICES • ' s •
ENVIRONMENTAL HEALTH DATE BASIS FOR'FEE AMDUNT I RECEIPT
303 NORTH 4TH / P.O. BOX 186/SHELTON,WA 9858 �/� J„f�„'t +�� p
PHONE (206)426-5561 t_V,L S. _ 7
APPUCA NA SITE: proved ❑NQt:ApprovCd
ADD _(1' --Dix BY:
`10 LArL'zWn-' nu
uo ERTY OWNER DESIGkKSTfM REQUIRED
ADDRESS PHONE INSTALLATiONi C]Appfdaed. WNOt,.AINNDYed
3 - t0— o BY:
SEWAGE ) '" SEWAGE
CONTRACTOR IJ ���/J�' DESIGNER
GAL DESCRIPTION DE,R,TH TO WATER TABLE
SOIL TYPE: r �" ' rah
TYPE OF ,�/ - NO. OF LOT 'I///�/�����[[ �j�f
BUILDING L /�� BEDROOMS - SIZEF' ��'�:;Te+r
WATER SYSTEM SINGLE RESIDENCE
SYSTEM F] PUBLIC NAME NAME
c/GZ'1 air!
COMMERCIAL ONLY
LIQUID WASTE G.P.D.
DIRECTIONS TO SITE: SEPTIC TANK(S) GaAI-. PUMP REck
— fP F iat/ 1.14 DISTRIBUTIONTILETOTAL
J P'6- f,1t7 d cad E'A FILTRATION AEi TOTAI,' ,,..,,BOk#;AcREFEET
ek^leoeIT a NER
ell
ONE
l $dPE
1ONE
SITE PLAN AND SPECIAL STIPULATIONS
(INDICATE DIRECTION OF DRAINAGE) pjppf `
OFFICE COPY