HomeMy WebLinkAboutHeadquarters - SWG Application / As-Built - THQRSTON-MASON SEr1Id'H DISTRICT IJo.
Division of Sanitation
Court House A�►es � Court House :annex
Shelton, lTaehington ' 1 P Olympia, Washington
Phone 426-8515 Phone 352-4851
APPLICATION TO CONSTRUCT OR AIM AN INDIVIDUAL WAGE DISPOSAL SYSTEM
(Application req uired for each installation)
Property Owner Telephone
(Plead4 Print
Aeiling Address
Address of Site
Location of Property, including: Lot ; Block,¢ Other
Detailed directions to site:
Property Commercial
Size Residence No. Bedrooms Basement Type
dater Supply: `.!ell Springy Other
Is auy Watre ,�
lr supply or body of water within 50 feet of sewage system? Yes_No
Septic Tank / �s]lons. ??!Drainage tam length feet. Trench 4iitlth P'D.
(Refer to Table 1 of Bulletin) (Reer to Table 2 of Bulletin)
And/or system other than above
Check for Installation oft
Automatic laundry ( ) Automatic Dishwasher ( ) Garbage Grinder ( )
Is Contractor installing septic tank? yes_ Nc Drainfield? yesvno_
j Name of Soilage Contractor C.titi.c]
Sewage contractor must be licensed by Thurston-Nsson
Health District
SIMMOH PLOT PLAN AND PLANS OF PROPOSED SYSTEM ON SEPARATE SHM OP PAPER
TEE UMZWIGNED hereby applies for a permit to construct a now ( ) and/or
alter ( ) a sewage system on above property in accordance with the Bulletin.
Applicant Ia Signature
Address
Bulletin. Iloshin3ton State Department of Health Bulletin .S. No. l entitled
Septic Tank System for Your Home for minimum requirements.
(Not to be filled in by Applioant) - - - —
Permit No Fee Date Issued — By
Area Sanitarian
Dates Inspected— Remarks
Date AunrovedO _ - Approved By Llanitarian)
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