HomeMy WebLinkAboutBLD CD Environmental Health Review - 4/25/1969 4K. ,a lmevf c V y
Thurston-Mason Health District 'a. g5- -
5th & Birch Court House Annex 1 95
Shelton, Washington DIVISION OF SANITATION Olympia, Washington
Phone: 426-4407 q p pk _&m /_� BrsAMAPeq g4 ,� Phone: 352-4851
T7"""` (Submit in Quadruplicate) �I
DO/NOT WRITE IN HEAVY OUTLINED SECTIONS r� p
Owner ... _.. .hf /.t7.1.J35LC.K_......._._. ..._...�...i__...._...._.... Phone
Mailing Address .—0.v •`�.¢. tl�........_...... City iQ'w�.►..�.-A_. State .........L;-l-"..............
Builder ................./.......................................................Address ................................._................................J...
Sewage Contractor f.^:mr.....,4.r ,f.rc ........Address .1.1.[ 3....:ga.t�.., 3-2--...I ..j Zaej'-P
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Legal Description ...........Zo .._R_C.t.�........ .._ _:...X........ ..........
............................................... ..........gw.,e.9.&ez.rl ..... ..............................
ParcelNo. ................................................................. Field Book No. .......................................................... y,
Directionsto Property ...................................................................................................................................... o
...................................................................... ..........._...........................................................................................
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Intended uses of �4'#.'....��..............Public Sewer ........ Water Supply .. '.a.t.. .........., In
No. of Bedrooms__1_.. No. of Bathrooms................ Basement................ Septic Tank... ',Z.SQ
Typeof Soil ........................'. ................................................. Lot Size ............................
Soil Drainage: Good...._C .../......... Moderate.... Poor....._..._....... ._ None.... ..................... M
DRAW SKETCH in blank space or on separate sheet indicating the following:
1. Property lines and location of house on lot and indicate minimum and maximum setback$ plus
dimensions of lot and all buildings.
2. Location of house and sewage disposal system in relation to streams, lakes, wells, patios,
driveways, underground tanks, water supply lines and easements.
3. Location of all interception drains or french drains.
4. Proposed fill, including depth, area, porosity and amount.
APPLICANT'S SIGNATURE ........... ....._._.......... .. ... ....._.... DATE
Site inspection fee $5.00 Receipt N i ..-7_7...... By .. ... .......................................................
Approved Not Approved .................... B
44 y ... . ... t ...............................
DATE fANIT11A1AN