HomeMy WebLinkAboutSWG1996-0349 - SWG Application - 5/29/1996 VI\'JIIL JLYY.-.wrw .�. rma. . . . . . ..... ...... . .... .... .... .� _...-_ .
MASON COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT NO. SWG�
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426 W.CEDAR/P.O. BOX 1666/SHELTON, WA 98584 Date o o H
PHONE (360)427-9670 Receipt No. z
Amount$ y m
CHECK APPLICABLE ITEMS ✓ m
G NEW SYSTEM
MAILING ADDRESS: DAYTIME PHONE: �.
_ I REPAIR SYSTEM
CITY: STATE: ZIP: MAINTENANCE REVIEW v
SINGLE FAMILY A
PROPERTY ADDRESS: OTHER
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rsup D — S6 NiIL3 vr� SPECIFY:
SPECIFIC DIRECTIONS FOR LOCATING SITE: PRIVATE WELL O n
,., O COMMUNITY WELUPUBLIC SYSTEM I-SYSTEM WFI N
�O D O� I SYSTEM NAME
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✓ NAME
Name of Lot �ft.x��R MAILING ADDRESS — ACV
Installer
Size: ]a acres TELEPHONE
Nameof um ero lIG RE
Designer edrooms lM. x A
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OFFICIAL USE ONLY. DO NOT WRITE BELOW DOUBLE LINE.
SOIL LOGS
Depth from Original
Grade to Restrictive
Layer or Water Table: In.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Findin Score Designer Level: O One ❑Two
Soil Type
Septic Tank Daily
Vertical Separation =n. Capacity: Gal. Flow: GPD
Slope Appl, In It.
Parcel Size Ac. Rate GPD/FT' Area F-P
Distance to Shoreline 1. FT—owl Inspector Date