HomeMy WebLinkAboutSWG95-0444 - SWG Application - 6/20/1990 OHF.SITE sINjIIdjjjfSftM SITE EVALUATION DISPOSAL PERwr
PERMIT NO. SWG GB- Zi
MASON COUNTY DEPARTMENT OF HEALTH SERVICES g
426 W.CEDAR I P.O.BOX 188E 1 SHELTON.WA 98884 Date
PHONE 1380)42]-98]D RT Pt o_ 9
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MAILMD ADDR S: _ 3� REPAIR SV6fFll 9
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SPECIFIC DIRECTIONS FOR LOCATNO., ✓ A r PRNATE WELL
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VI DESIGN REVIEW:O Apyowd �NatAwtowtl INSTAt1ATI0NUAIRaowd UNd ADptoYe
BY: WTE: BY: DATE: BV: DATE:
TOP:Health Dept.Copy MIDDLE:Deaignefs Copy BOTTOM:Applk s Copy
ON-SITE SGWAGE SYSTEM SITE EVALUATION AND DISPOSAL PENMR
PERMR NO. SWG
• MASON COUNTY DEPARTMENT OF HEALTH SERVICES -
M26W.CEDARI P.O.BOX I866/SHELTON,WAS85N
PHONE(206)Q7-9670 "Gumt '3F
CHECK APPLICABLE ITBIS 5 r ✓ i
MA OAD Ess: a EPI{r. r REMRI NNDDG IE wS YSTEM
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O EFT 669 ER ew - PufllSYSTEMEY
SAr TX O TO �, • sa: N N- ,LE DRs ofT BYSTEYID NYBBI
END• SYSTEM NLME h
c2 APPLICANT ImAgurn JhahhcIE ALE SAME
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Name of Lot 13o tta�pS D. 1WWGADDRE33
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DESIGNER DESIGNATION SCORFS A• NNUM SYSTEM REQUIREMENTS
Rna S � DeYprxrr Level: OOne Two
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BY. ,hw�DATE I BV: DATE: BY: DATE'
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TOP:Hea101 Dept Copy MIDDLE:Design's Cagy BOTTOM:Applicanrs GDpy