HomeMy WebLinkAboutAPPLICATION FOR RE-EVALUATION - SWG Non-Occupancy Notice - 8/13/1993 MASON COUNTY DEPARTMENT OF HEALTH SERVICES
POST OFFICE BOX 1666
SHELTON, WA 98584
(206) 427-9670
FAX 427-8425
APPLICATION FOR RE-EVALUATION
P i.. 09/01192
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1.
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Couplets Pert A son sone,t W the Direfort Of eselh, "rejoes, 196, 3,�hhn. WA 98564.
2. The ditechor .111 ses- - "her'sin't..n to pert 3 Msrhsr a nln.potlm is Justified. efen a reim,mth-
tion is ejeia, the fimdlW. of the scrod Uvithhosentel MeeltO Slee""t st'l "h'the" in Pert C. A final
d.tartaination by the olrvrror is recorded in parr D.
3. XppJicshta are billtel sh teioltlomal $40 when & nlnapctlm is he'Foiren' end she seh's"re" to my for shy
.."aar, leforatac, =or* "shoiated with soll tests' =10" rkto hesitt os .t 1. samonstferewt
to
. . error soil type.
1. J,hnlWa and demreinetlam
of the aretron, se, he appess, to the mern canat, Hesita officer at the
address listed slert0-
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• AppliCfnt'$ HIL120
Address: 7009
• Telephones
L.T
• Health Department finding being disputed by applicants
depth of ❑ sall t"/.'licatiom rats Depth Or Pressor of settling
Mee or ee
M1pnnets =fl ildv j6± 77Tll, S�� L�i
See-
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as Dotoraimtian of Director
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E Reinspection is justified and will be scheduled within 7 working days.
El Reinspection is justified, and a sample of soil at the applicant's re-
quest will be sent to a certified soil testing laboratory for analysis.
(The department will accept responsibility for payment of associated
Laboratory costs only in the event the staff findings on soil type (as
delineated In }PAC 246-272-094) were determined to be incorrect. )
Reinspection is not justified, and findings and actions of staff were
determined to be consistent with departmental policy and procedures.
Reinspection Is not Justified, for the following reason(s) :
Other comments:
Director of Health services Date
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ce
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Part C, PAinspwtim Findin" (0-ploted if Applicable)
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Environmental Health Specialist Date
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Pert Dn MisinjugLM of Disput" (Cmpleted if AVV1LC&b10)
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Director,0f Health Services Date
$ LU
silling unt