HomeMy WebLinkAboutSWG3527 - SWG Application / As-Built - 7/26/1973 " T06RST MASO HEA TH DISTRICT.
mutt & Birch,'P.O. Box 746 6 _ 11.. �;5 _ /
Shelton,, Wash. 98584 IV 1`ION OE'EN VIRONM AE HEALTH Courthouse Annex
Phone: 426-4407 L1� oxtet/ Olympia, ash. 98501
I �✓J-Al C"'� am- PhoneLl
:
OWNER L CH (a I�p(;� �'�. J�a rr� y PHON
OWNER'S ADDRESS_ qp /. lye .Zq 1h CITY&/L7'{,L4 e- STATE _VyC�Sh
SEND REPORT TO�t - L�G -5 /S� CITY,' e'(�.! -yj STATE Va,-s
SEWAGE CONTRACTOR 1, 4 / Iarl- ADDRESS 17.E 5' Q I y . ) ,
(If self, confer with E.H.S.) // !p '7�—
LEGAL DESCRIPTION �S 711 d fYQC� � rNn7['CC/C1L'C7 t> 1 f�Ltl"� J •N E7tf ![!'vilS
PARCEL NO. LOT SIZE 75"h LS rrCC INTENDED USE OF BL�G. 1 f'c [°ak;;4
NO. OF BEDROOMS_/_NO. OF BATHROOMSBASEMENT PLUMBBING: YES NO l�
NAME OF WATER SYSTEM p INDIVIDUAL tell, PUBLIC COMMUNITY_
DIRECTIONS TO PROPERTY: (Be Specific) y-taaje_ 6 r e el IE=-f��:� M l e jo
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g,4C1-k-to ar,rCtt Pmatlk�,,r
DRAW A AFTCH SHOWING: 1. Property lines, location of horse on the lot, and dimensi ns of the
lot. 2. Location of the house and sewage disposal sys)einrelation to streams, lakes, wells,
soil log holes, patio, driveways, undgr tanks, �+ supply lines and easements.
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f31v�Cr —yea n
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'mh to roc ii b� Alc �em u,.D
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The septic system--is an appro—VCd temporary metho o sew ,�j"
disposal until sanitary sewers are available. I" ) � I
DO NOT WRITE IN THIS SPACE yu � f-J Ae,
ftjyye;n 504'tToWt Iand/ea�� la c� s , �'n�
MINIMUMS:
('feco�ne� :2 u,-mP cn KS
Septic Tank
Drainfield �� Scr� eS rova,l
�m fed t',., m, Fi,r �c9vl(�i iCJvL1 � �P;"A'Pticl ` c) 6e 'cecs;uecl•by
-t 4.-S O'fsr,C'e a ri d a Cc e q? t y �0. f11 +1rt
Prtub e "hc� aep7 , a,cklvn f�w:Tl��in l00AayS
E AP LICATI N
,
APPLICANT'S SIGNATURE • DATEITE
APPROVEINSPECTION FNOT PPROVED C NO Y_ B
CA
Date Date - Inspe or/
L-...! SEWAGE APPLICATION NEW / / ALTERATION
APPLICANT'S SIGNATURE DATE
FEE Q no RECEIPT NO. BY
PERMIT N0. t APPROVED. BY -
Date InspeeDcto .H.S.
i
SEWAGE SYSTEM CERTIFICATION
Property Owner
Sewage Contractor Addresses
l• Scale: 1 Square = 10Date 6 f Parcel, �--
2, Draw in physical structures to be on lot,
4* Show 3. Show location of well or any body of water,
5. Assume oant elevation ion Of pofc1system in relationship to structure.
elevations in relation to itat one lot corner &
6. Use Arrows to show direction of indicat the other lot cor
slope,
too
} Y
r,
Wr
i 1Ilk Y
�e.
Septic Tank Volume
Drainfield Length r
/ Cubic Yards gravel used
1 certify that this system is installed as
requirements shown above, an that all-
and standards of Thurston-Mason Health Distric been satisfied, have
Signature
Contractorls License #
June, 1970
I
SEWAGE SYSTEM CERTIFICATION
tY PC, Ofter_ Address
ig•e COhtractor Date JAL
Parcel#
kale: 1 Square = 10'
raw in physical structures to be on lot.
how location of well or any body of water.
how location of septic system in relationship to structure.
13sume an elevation of 100' at one lot corner & indicate the other lot corner
Levations in relation to it.
,,e Arrows to show direction of slope.
�10
ILI
f %
Septic Tank Volume
Drainfield Length
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 I'
been satisfied. -9
Signature/ � /s ,
Contractor's License
19,( s 1
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