HomeMy WebLinkAboutSWG Application - 4/30/1984 SEWAGE SYSTEM PERMIT APPLICATION No. Permit Expires CLL'rt/,(w—
MASON COUNTY HEALTH DEPARTMENT FOR DEPARTMENT
ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMOUNT RECEIPT NO.
303 NORTH 4th STREET • SHELTON, WA 98584
PHONE (206) 426-5561
AWLICANi SIGNATURE
ADDRESS RIOrE �
PR SITE: ❑ Approved El Not Approved
OLfRLV O WNE R /
1./,
ADDRESS gpPl BY:
17�• d i�c��aT♦ DESIGN SYSTEM REQUIRED
SEWAGE ' SEWAGE
CgJIRACTOR ..-.<'r �'�' [ESIGNER - _ INSTALLATION: ❑ Approved ❑ Not Approved
I[CrAI DFSOLIRION .J
%e xi Z ' Ac, BY
DEPTH TO WATER TABLE
ML nI M.Ie �cn.r BEDROOMS�LOT
SIIZE_'- SOILTYPE
SINGLE RESIDENCE PUBLIC WATER NAME
WATER SYS" SYSTEM
COMMERCIAL ONLY
LIQUID WASTE G.P.D.
DIRECTIONS TO SITE:
/ - P v Jx tEPTIC TANK(S) GAL. PUMP REQ.
DISTRIBUTION TILE TOTAL FEET
{ FINAL INSPECTION REQUIRED BEFORE BACKFILLING
DEPTH OF
m A �' .} E�BACKFILL
2"STRAW OR PAPER
J. .- Ie f E O STONE
OVER TILE
\� F�PIK SIZE
E�STONE
SITE PLAN AND SPECIAL STIPULATIONS UNDER TILE
(INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH
BLDG. DEPT. COPY 1121/ 4,.7 .Y.YJ7D