HomeMy WebLinkAboutTahoma Staff Shower - SWG Application / As-Built - 6/9/1972 _ i
5th'6 Birch, P.O. Box 746 THURSTON-MASON HEALTH DISTRICT No. �03$
Shelton, Wash. 98584 OIVI¢ION OTLNVIaONMLNTALNLALTN Courthouse Annex
phone: 426-4407 Olympia, Wash. 98501
/^ Phone: �3`52-4851 E%T 84
OWNER ��Ln.t.PJt cec ^, c� C PHONE
OWNER'S ADDRESS SAdbla CITY STATE
SEND REPORT TO Ae&kA 2 CITY�STATE a / ,—
SEWAGE CONTRACTOR ADDRESS L 2 Z
(If self, #hfer with E.H.S.)�/' (� 'T Q 3
LEGAL DESCRIPTION �,R) /4f—P 41 _ / / Y,_cr'L A/
PARCEL NO. LOT SIZE INTENDED USE OF BLDG.
NO. OF BEDROOMS NO. OF BATHROOMS BASEMENT PLUMBING: YES NO
NAME OF WATER SYSTEM INDIVIDUAL PUBLIC COMMUNITY
DIRECTIONS TO PROPERTY: (Be Specific) d
DRAW A SKETCH SHOWING: 1. Property lines, location of hnnse on the lot, and dimensions of the
lot. 2. Location of the house and sewage disposal system in relation to streams, lakes, wells,
soil og holes, Apatio, driveways, underground tanks, water supply lines and easements.
i3ar Coe- 14e31t `�?
The septic system is an approved temporary method of sewage
disposal until sanitary sewers_are available. _
DO NOT WRITE IN THIS SPACE
MINIMUMS:
Septic Tank
Drainfield
SITE APPLICATION / 1�
APPLICANT'S SIGNATURE
SITE INSPECTION FEE_46Z_j3gd0CEIVr NO. BY
APPROVED NOT APPROVED BY
Date Date Inspector/E.H.S.
/=T SEWAGE APPLICATION NEW /—T ALTERATION
APPLICANT'S SIGNATURE DATE
FEE RECEIPT NO. BY
PERMIT NO. APPROVED BY
Date Inspector/E.H.S.
4 04,4n
l7am� / SEWAGE SYSTEM CERTIFICATION
Property Owner 04,4 nj/J nn n ' }-`� Address r'
Sewage Contractor �ii e.1�t iYn [ Date Z:. (L l Pa cel# 11LA a_i
1. Scale: 1 Square = 10,
2. Draw in physical structures to be on lot.
3. Show location of well or any body of water.
4. Show location of septic system in relationship to structure.
5• Assume an elevation of 100' at one lot corner & indicate the other lot corner
elevations in relation to it.
6. Use Arrows to show direction of slope.
100
i
AS
o �
30
Septib,'1'ank Volume
Drainfield Length
Cubic Yards gravel usedld
I certify that this system is installed-'as shown above, and that all-
requirements and standards of Thurston-Mason Health` District have 0
been satisfied, Signatures �� P 1 (� �+
Contractor's License # `�2 �^ / ^p ye �J
June, 1970
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