HomeMy WebLinkAboutSWG2021-00098 PERMIT CANCELED-INCOMPLETE - SWG Inactive - 2/25/2021 OFFICIAL USE ONLY
DATE RECEIVED:
MASON COUNTY -- 0-5-0-4 cn cp
COMMUNITY SERVICES AMOUNT�F...L3: Qv RECEIVED BY: COv m
Public Health(Community Health/Environmental Health) tom_�Y�����eJ, C �
t 360-477 9670,ext.400 or 36o-775 4467,ext.400 �� ^ T Q
ni5 N.61h Street Shelton,WA 98584 '(^ Oco l O xl
ON-SITE SEWAGE SYSTEM APPLICATION
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PHONE
APPLIC•-Tm
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CHE' HUSTON 360-470-8465 z
MAILING ADDRESS- REET,CITY,STATE.ZIP CODE c
1227 W LA .SIDE DR SHELTON WA 98584 03
SITE
ESW STREET
LAKESID-CODE
1246 DR SHELTON WA 98584 I ('
NAME OF DESIGNER PHONE
NAME OF INSTALLER PHONE 0 I (CI
B-LINE CONSTRUCTION 360-426-4221 R•• I
PERMIT TYPE(select one) DRINKING WATER SOURCE - O
17.5
F RESIDENTIAL OSS h- COMMUNITY OSS Fl COM •-CIAL OSS 1-1 PRIVATE INDIVIDUAL WELL b PRIVATE TWO-PARTY WELL Z I
TYPE OF WORK(select one) �7 (r PUBLIC WATER SYSTEM
h P NEW CONSTRUCTION/UPGRADES REPAIR/REPLACE NT OTHER DETAILS(select all that apply) 0 TABLE IX REPAIR I Ul
SUBMITTALSMI 0 SURFACING SEWAGE 0 EXISTING FAILURE SHORELINE co
WDESIGN FORM(REQUIRED) H SEPTIC DESIGN(REQUIRED) : DROOMS LOT SIZE r O
EWAIVER(S)(IF APPLICABLE) 2 258'X66'X304'X54' 0 1
x I O
DIRECTIONS TO SITE AND SITE CONDITIONS.(ex locked gate)
GO OUT CLOQUALLUM ROAD, TURN RIGHT ONTO AKESIDE DR, GO TO ADDRSS,
PARCEL IS ON THE RIGHT SIDE OF THE ROAD. C-4
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SOME OF DRAINFIELD IS FILLED WITH ROOTS.
SITE MUST BE FLAGGED FROM MAIN ROAD AND TEST HOLES MUST BE FLAGGED WITH TEST HOLE NUMBERS. ( 0
OFFICIAL USE ONLY BELOW THIS LINE III
UPGRADE/FAILURE SOURCE(for reporting epo g purposes)
❑VOLUNTARY 0 MAINTENANCE/PUMPING ❑BUILDING PERMIT El HOME SALE ❑COMPLAINT ❑OTHE-
INSPECTOR SOIL LOGS COMMENTS I CO I '
ou C. ....1\(\ie211 . \
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75
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RECORD DRAWING AND N TALLATIO - eiT -.
SOIL CODES:
V=VERY G=GRAVELLY S=SAND L=LOAM Si=SILT C=CLAY E=EXTREMELY R=ROOTS REQUIRED FOR FINAL APPR VAL,
INSPECTOR SIGNATURE DATE APPLICATION EXPIRATION DATE APPLICATION APPROVED/ISSUED BY .`ATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED 12/7/2015
Mason County WA GIS Web Map
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2/22/2021, 12:35:48 PM 1:12,301
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[- County Boundary I r (' t I ' , ' , ' , t I
0 0.15 0.3 0.6 km
`-, Tax Parcels (Zoom in to 1:30,000)
Sources:Esri.HERE,Garmin,Intermap.increment P Corp..GEBCO.USGS.
FAO. NPS.NRCAN,GeoBase. IGN, Kadaster NL, Ordnance Survey, Esri
Japan,METI,Esn China(Hong Korg).(c)OpenStreetMap contributors,and
the GIS User Community
Mason County WA GIS Web Map Application
Esn,HERE,Garmin,FAO.NOAA.USGS.EPA,NPS I Richard Diaz i