HomeMy WebLinkAboutTwahah Staff Showers - SWG Application / As-Built - 6/9/1973 Sth b Birch, P.O. sox 746 THURSTON-MASON HEALTH EhSTRICT No.
Shelton, Wash. 98584 OIVI¢ION Of ENVIRONMENTAL HEALTH Courthouse Annex
Phone: 426-4407 Olympia, Wash. 98501
Phone: 352-4851 EKT 84
OWNER 1"' V ` �`'L'�t.P.)1 �Or'^�'^�a-C.c 'L�N l-C PHONE 7/3 J
OWNER'S ADDRESS / J I CITYTATE�
SEND REPORT TO __A ,.P-�' a,L CITYJ�Q.C.,O�II•Tc+r,STATE
SEWAGE CONTRACTOR -�-� ADDRESS
(If self, nf[er/ with E.H.S.)(/
LEGAL DESCRIPTION S to j I LF
PARCEL NO. LOT SIZE ` INTENDED USE OF ELDG.
NO. OF BEDROOMS NO. OF BATHROOMS BASEMENT PLUMBING: YES NO
NAME OF WATER SYSTEM INDIVIDUAL PUBLIC COM4UNITY
DIRECTIONS TO PROPERTY: (Be Specific) 1
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, patio, driveways, underground tanks, water supply lines and easements.
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i
ca
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
APPLICANT'S SIGNATURE ..Po DATE
SITE INSPECTION FEE CEI NO. . BY /
. APPROVED NOT APPROVED BY
Date Date Inspector/E.H.S.
%/ SEWAGE APPLICATION NEW /-7 ALTERATION /__7
APPLICANT'S SIGNATURE DATE
FEE RECEIPT NO. BY
PERMIT NO APPROVED BY
i Date Inspector/E.H.S.
a
SEWAGE SYSTEM CERTIFICATION /n
Property Owner l_ \ d�G KJ Address ?` ' r
Sewage Contractor 1.a-4�e-J4 7`'� �T�ne Parcel#
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�
641at
4L'x'
S
r Al-No,
r
! V
D C E U
t'
th..h and
Septic Tank Volume
Drainfield Lengtl
Cubic Yards gravel used
I certify that this system is installed as shown above, and' that all-
requirements and standards of Thurston-Mason Health District have
been satisfied. Signaturs'2:4 �L(��11�t ppp
Contractor's License # B
June, 1970