HomeMy WebLinkAboutRangers Home - SWG Application / As-Built THURSTON-MASON HEATMH DISTRICT No. '
Divisi of Sanitation
Court House Annex Court House i4nnex
Shelton, ?/ashington Olympia, Washington
Phone 426-8515 Phone 352-4851
APPLICATION TO CONSTRUCT OR AL M AN LNDIPIDUAL SMIAGE DISPOSAL SYSTEM
(Applicatior# required for each installation)
Property Owner. ��"" .Telephone
!failing Address kPlea Print ,_
Address of Site
Location of Property, including: Lot BloW Other
Detailed directions to site:
Property COmmeroial
�
Sage Residence No. Bedrooms _Baeement Type
!later Supply: !ell Spring_ Other
Is any water supply or body of water within 50 feet of sewage system? Yes $- o
Septic Tank lone. Drainege System Lengt�0 7eet. Trench wid Ft.
(Astor to l�Bulletin) (Refer to Table 2 of Bulletin)
And/or 8"tem other than above
Check for Installation of;
Automatio Laundry ( ) Automatic Dishwasher ( ) Garbage Grinder ( )
Is Contractor installing septio tank? yes NO_ _D airfield? yes no
Name of Sewage Contractor O/X^, " ':
Sewage oo for must be ioensed by Thurston-Mason
Health District
8RE' M PLAT PLAN AND PLANS OF PROPOSED SYSTEM ON SEPARATE SHEET OF PAPER
THE UIUMSIGHED hereby applies for a permit to construct a new ( ) and/or . '. *
altar ( ) a nt'ssewage eyeture- 4 above p2yaezts anoe with the Bulletin.
Applicant's Signature- 4 ��"
e �
Address
Bulletin: llashinrton State Department of Health Bulletin No 1 entitled
Septic Tank System for Your Home for minimum requirements.
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-(Not to be filled in by Applicant) - _- - --- --
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Permit No Fee _ Date Issued_ By
Area
Dates Inspected_ Remarks_-
- _-- .___---------
Date Approved _� A proved O
Sa7ta7a-a
now
24
71
17
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