HomeMy WebLinkAboutSWG2021-00138 EXPIRED - SWG Inactive - 3/19/2021 OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH D.'F EDS F, _ 1c _ a6 a I y D
ONSITE SEWAGE SYSTEM APPLICATION AMOUW RE INFD _ MEB m DO
415NMS#eet,(Bld08) SheltonWA,98584 w
Shelton:360427-M70MMO Betlair:36P2754%7e,14y SWG �- y O
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APPLICANT R1JNE D D
COMMUNITY MANAGMENT GROUP 206-992-6901 PATRICK m IT
MMUNGADDRESS-STREET.CRY SATE.ZIPCOW r
17837 1ST AVE S, PMB#363 NORMANDY PARK WA 98148 W 3
SITE ADDRESS-STREET CRY,ZIPCODE m
261 SE CRAIG RD SHELTON A 98584 a
NAME OF DESIGNER HE I w
JIM HENRY 360-507-126 4
NAMEC£INSTALIER PHONE N I N
CHECKALLAPPLIGBLEITEME DISNKN/ITY/PUSLIC
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C3 NEWCONSTRUCTION ❑ RVHOLDINGTANKONLT 0 PALWELL y W
p0 REPLACEMENTSYSTEM ❑ INSTALLADONPERMITONLY 3 PTYWELL O
❑ TABLE 9 REPAIR ❑ SINGLE FAMILY tl C NNTER SYSTEM ZN
❑ TAN((S)ONLY ❑ COMMERCAL BLUEBEMPARK
❑ UPGRADETOEASTING if OTHER:MOaIIEHOME PARK BE S ? LOT SIZE IN
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FROM SHELTON, SOUTH O3 TO LEFT ON SE CRAIG RD TO SITE 10
ON LEFT. I 10
REQUEST TO MEET ON SITT HOLES, PARK SPACES 4 -9A o 10
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SRENIIST BE FL9GGEOFES MUSTBEFL1GfiEB MlTM iE$T IM{EMIAOER$ 10
OFFICIAL USE ONLY BELOW THIS LINE
UPGRADE I FALURESOURCE(lnte{a,tiry[umua
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INSPECTORSIGMTURE E APPL 1ON EXPIMTCN DATE APPUCATIONAFPROVEDBY DATE
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSDE RINSED W4015
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