HomeMy WebLinkAboutWEL92-00014 - WEL Application, Design, Letter - 8/6/1992 uk-�Ra - -Dolq
MASON COUNTY r� T.� D
DEPARTMENT HEALTH SERVICES lu�+U�
Moron County Bldg.III 426 W.Cedar t�
P.O. Box 1666 Shelton,Washington 98584 QUO'
(206)427-9670• Bedoic 275-4467 �JJL
7 Seattle:464-6968•Other: 1-800-5625628
environmental health personal health HEALTH SI. R ICErr quality
$35.00 fee due with application Please make check payable to:
Mason County Treasurer
APPLICATION FOR WELL SITS INSPECTION
Name of Proposed Water System e e, /wrsJ3^-
Name of Applicant 12 tiuz— Af� . , L / S9`- A 6 ,,,/Z
Address of Applicant Po• Ro,c 75�Y '
Phone Number of Applicant !�,2� - 31?a
New or Existing Well? 7S 7re, GJe.�
Parcel Number of Proposed Location 32/36 ;2/
Legal Description of Proposed Location —�� 2 / /V �![�
Section - Towns ip Range
Maximum Number of Services of Proposed System
Well Driller 5 /I e0 A- 0e le,. '11
Water Right Application Number b4
(required for wells pumping overr 5, 000 gal/day and for
commercial wells)
Precise Directions to Proposed Well Site Location f-/Azl.r 9 Psl-
0J� r ..11 i. S�r2 Li e7r. r /Le rYti r. �07
Comments
��,.,� XX FOR DEPARTMENT USE ONLY
Pee $�pLX Rcpt '51y,3 Date 1 Clerk r r
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