HomeMy WebLinkAboutWEL94-0107 - WEL Application - 12/16/1994 Ar
MASON COUNTY
DEPARTMENT of HEALTH SERVICES
Mason County 81dg.III 426 W.Cedar
P.O.Box 1666 Shelton.Washington 985U
CM)427-9670• Bettair.275-4467
Seattle:464-6968 •Other. 1-800-562.5628
environmental health personal health water quality
$35.00 fee due with application Please make check payable to:
Mason County Treasurer
APPLICATION FOR WELL SITE INSPECTION I ( LC�/ _ao/
Name of Proposed Water System Lake Park No. 5 vvv �l `Jlv
Nance of Applicant David C. Bayley
Address of Applicant P 0 Box 278,
Shelton WA 98584
Phone Number of Applicant 206-426-9713
New or Existing Well? New
Parcel Number of Proposed Location portion of 42001 44 00000
Legal Description of Proposed Location G. L 112. Sec 1. Twp 20N R 4 W W.M.
Section - Township - Range
Maximum Number of Services of Proposed System 6
Well Driller Arcadia Drilling Company
Water Right Application Number not applicable
(required for wells pumping over 5, 00o gal/day and for
commercial wells)
Precise Directions to Proposed Well Site Location .4 mile from
intersection with Shelton Springs Road and Island Lake Road. South line of property
is on Island lake Road. NE corner of property is on Island Lake Drive. See map
osecl
attached. The/site is 20 feet North of 4 other proposed well sites.
Comments None, previous 4 well sites were inspected back in October of 1994
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FOR DEPARTMENT USE ONLY
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