HomeMy WebLinkAboutSWG2021-00139 EXPIRED - SWG Inactive - 3/19/2021 OFFICIAL USE ONLY
MASON COUNTY PUBLIC HEALTH BKE ED
ONSITE SEWAGE SYSTEM APPLICATION MpMR E ED _ MEe�K o y
415 Nfith Street,(Bldg 8) SheIMDWA,98584 < to
N
SheNDn:8fiw31-9fi10 ext 400 BeNaiD 360 375-001 MR4g0 SWG ,1 _ ,I o A
V✓ 2 N
z D
APPLICANT PH20ONE D
COMMUNITY MANAGMENT GROUP 6-992-6901 PATRI m m
MA UNGADptE33-STREET.OTY STATE,ZIP CODE r
178371STAVE S, PMB#363 NORMANDY PARK A 98148 Do8 37B-STREET CITY ZIP COOP
m
261 SE CRAIG RD SHELTON WA 98584 # z
NAMEOFDUIGIER PHONE I (a
JIM HENRY 360-507- 7 FwJ I N
NAME OF INSTALLER PHONE
CHECKAIIAWLICABIE ITEMS DRINKING WATER S CE O l O
I]J NEW CONSTRUWON ❑ RV HOLDING TANK ONLY ❑ PRNAT IDIVIDVAL WELL N W
If REPLACEMENT SYSTEM ❑ INSTALLATION PERMIT ONLY ❑J PRIV TWO-PARTY WELL O
I] TABLE BREPAIR SINGLE FAMILY tl C VNITYIPUBLIC NNTER SYSTEM = IN
❑ TANK(S)ONLY ❑ COMMERCIAL SYSTEMNAME a EBEARPARK
OF
❑ UPGRADE TO EXISTING if OTHER:MOBILE HOME PARK S LOT SDF N
d EXISTING FAILURE ten 7 W I W
DIRECTIONS TO BRE-BE SFEGFlLANDADNSE OFANI'NEEDFDINFGRMATIONF CESS N` I0--.) O
FROM SHELTON, SOUTH ON OLYMPIC 3 TO LEFT ON SE CRAIG RD TO SITE
I�
ON LEFT. o
REQUEST TO MEET ON SITE TO IEW TEST HOLES, PARK SPACES 1 - 3 0
N
SITEMUSTBEFNWEOF AWN ROAD AM TESTNDLES MUST GGED WITH TESTHOLE NUMBERS C3
OFFICIAL USE ONLY BELOWTHISIKE
UPGRADE/FAILURE SOURCE NwnpwMp glryseel
OVOLUNTARY O MAINTENANCE/PU G El BUILDING PERMIT ❑HOME E C INT ❑OTHER: _
INSPECTOR SOL LOGS COMMENTSICIXipTIONS
•
j �
I
1 �
I
I
1 N
1 v
1
1
1
WILCODE
V=VERY =GRAVELLY S=5W0 L=LWM &=SILT C=CUT E=EXTREMELY R=ROOTS
INSPEC RSIGNATURE mm APPLICATKINEXPIRATIONWTE APPUCATIONAPPROVEDBY DATF
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE REVISED'ZOMIS
O �
O
CRAIG RD -
3 D
z
x —
Z y �
'�•Q9° —O 1111
=N 1111 x �
n {� 1111 a m MOBILE
G � } 1111 N
O '' N I111 3
Tj'111 O
I
A �Kn
< m 31I90W m
V�a o l l 3lIHOW N
O o �
O
,\ x
3,100W
31I90W N
J <
II < <
0
\90O L �< < $ 311HOW x
no
_ l <
T
O
a 0 io= n 0 31190W m
O i N
f 06 1665
la zz I000 0 ~O 1 a m
z
m A x
� m r
z < <
I 0 m
5 u
O
F
m 1 O
m O 1 0 H
O m
0
Iz
r w A 9 L y AS
O ;O 0
D � 1 m � D f pp F
m g im x m 0 i`s
,my A u F `^D O
�n W
w A
-i
N C
N N o �' O
� 8QW cl ym
0 0 m n
G a Z
m m N
o 1 ; m
m � w
'gg n
Ym (n
m H
a Z m
N n
D
Z