HomeMy WebLinkAboutSWG Application - 5/16/1973 THURSTON-MASON HEALTH DISTRICT 3�gq"
Sth A Birch, P.O. Box 746 No.
Shelton, Wash. 98584 DIVISION or -xvuoxxex+Al xuitx Courthouse Annex
Phone: 426-4407 Olympia, Wash. 98501
Phone: 352-4H51 EST 84
OWNER -rtfoNI AS AFl yL FDONE !42� -d9/K
OWNERS ADDRESS RT /d/ ZQX//t f CITYS//E�7oA! STATE GP,pSN,
SEND REPORT TO/a,�yy7)laxydx a,L 7,`290-9-7 S7 UW, CITr-7: O/ STATE W AS N,
SEWAGE CONTRACTOR AUS eAV ADDRESS l`'byHutiP
p (If self, confer with E.H.S.)
LEGAL DESCRIPTION WAZ d, W/K S K(A SW �q M oZ 0
PARCEL NO. LOT SIZE 3 # INTENDED USE OF BLDG. ES
NO. OF BEDROOMS� NO. OF BATHROOMS /24 _BASEMENT PLUMBING: YES N0 _
1b, v1+1 ON 010 Mori,= ON S,Tay wNeN Nhw No•w� It FNaNEo/}1
NAME OF WATER SYSTEM u,6LL &trysRatn No"Aa RaS~INDIVIDUAL Z PUBLIC GOWMUNITY
WELL PVx PAXL T /NKd W,LL F(,RMi3N W*' '-`A MEW IfO,i6
pD,IRECTION,,SS TO PROPERTY: (Be Specific)g ROnn ayogw. (nf= h91 d-RgILtgNAi PQoe1*44 off
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DRAW A SKETCH SHOWING: 1. Property lines, location of hnnae on the lot, and dimensions of the
lot. 2. Location of the house and sewage disposal system in relation to streams, lakes, wells,
soil log holes, pa4io, driveways, underground tanks, water supply lines and easements.
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The septic system is an approved temporary method of sewage V `
dLs oval until sanitary sewers are available.
+'�NOTIN TBIB SPACE �PK eh—d VW � 9 4 D1� µ, e � hN ek,
0 MINIMOMB: l/
eptic Tank / J
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SITE APPLICATION
APPLICANT'S SIGNATURE
SITE INSPECTION FEE IQ a RECEIPT NO. 3
APPROVEkj-n tlOT APPROVED BY
Date Date Inspector .A. .
SEWAGE APPLICATION NEW PII.TE TIO /�
APPLICANT'S SIGNATIIREof//�nlx.9.n - DATE _5- Its- 73 .
FEE .20.00 RECEIPT NO "/ BY
PERMIT NO. a APPROVED BY
Date Inspector/E.H.S.
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