HomeMy WebLinkAboutSWG Application - 1/24/1983 SITE NO. '
MASON COUNTY HEALTH DEPARTMENT FOR DEPARTMENT USE ONLY
RE
ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMCRUNT NU�MIBER
42S WEST BIRCH STREET • SHELTON, WA. 98584 GG p
PHONE (206) 426-5 1 '�? 'f� G ,,�-Ilo . ly
APPLICA T SIGNATU }C/ '
1— C
ADDRE 74O E L V •.�S SITE: � APPROVED ❑ NOT VIED
ZSO CIA I
PROPERTY OWNER Y. BY;
I� ICN AR t 7 N�
ADDRESS ff PHONE \
W 2_50 L I q K FZQ • y 24- 7 S iq DESIGNED SYS EM REQUIRED NOT
SEWAGE SEWAGE
A ER SEWAGE: - ❑ APPROVED ❑ .APPROVED
CONTRACTOR J L-) ••r
LEGAL DESCRIPTION /' O - / '/ / BY:
Y NuJY� Q SOIL TYPE ~'
TYPE IN c -g"r BBEDROOOMS 2 SIIZE_ DEPTH TO WATER TABLE PERC. RATE
BUILDING M b E'
SINGLE RESIDENCE � PUBLIC WATER ❑ NlME SEPTIC TANK(S)�0 GAL. PUMP REQ I
WATER SYSTEM SYSTEM -
COMMERCIAL ONLY FEET
DISTRIBUTION TILE TOTAL 90 I
LIQUID WASTE G.P.D.DI
RECTIONS TO SITE: FILTRATION AREA r1�f)O SO. FEET
QUANTITY OF I
APPROVED STONE CU. YD. SAND CU. YD.
FILL REQUIRED CU. YDS.
a! FINAL INSPECTION REQUIRED BEFORE BACKFILLING
E�DEPTH OF
�awETLFIu
(� 7'STRAW OR PAPER
STONE
O OVER TILE
<_F-22�PIPE SIZE
STONE
SITE PLAN AND SPECIAL STIPULATIONS I� �'_� I UNDER TILE 0-
(INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH
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