HomeMy WebLinkAboutSWG Application - 9/29/1981 SITE NO. _ _1 /(7Kn
MASON COUNTY HEALTH DEPARTMENT FOR DEPARTMENT USE ONLY
ENVIRONMENTAL HEALTH SECTION DATE BASIS FOR FEE AMOUNT RECEIPT
NUMBER
-
428 WEST BIRCH STREET • SHELTON WA. 98584 -- _-- - �NUM
' PHONE (206) 426-5561 _ +�
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SITE: [] APPROVED ❑ APPaoveo
PROPERTY OWNER -
ADDRESS PHONE E E
DESIGNED SYSTEM REQUIRED_
YWA OF SEWAGE-- N T
CONTRACTOR L �•I;p _ T +. DESIGNER - _- - --- SEWAGE: ❑ APPROVED -- O APPROVED _.
L[GAl D[SCRIP110N
SOIL TYPE
TYPE NO. OF 2 LOT
BUILDING
G �. __ ---BEDROOMS —' - SIZE__.. _X_ DEPTH TO WATER TABLE � __ . _PERC. RATE... _--
SINGLE RESIDENCE PUBLIC WATER
WATER SYSTEM L3 SYSTEM SEPTIC TANK(S)_j GAL. PUMP REQ.•`IIk
COMMERCIAL ONLY ) + _-
LIQUID WASTE G.P.D.—_ _. DISTRIBUTION TILE TOTAL__ _--FEET
DI RECTIONS TO SITE: - FILTRATION AREA _ _SQ. FEET
QUANTITY OF
APPROVED STONE— --CU. YD. SAND _.CU. YD.
FILL REQUIRED _CU. YDS.
FINAL INSPECTION REQUIRED BEFORE BACKFILLING
DEPTH OF
:Z'STRAW
BACKFlLL OR PAPER m
T :] .1- !l f,. N /NNEjSTONE
OVER PUT
T PIPE SIZE
Q
STONE
SITE PLAN AND SPECIAL STIPULATIONS UNDER TILE
(INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH
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COMMENTS: -
THIS SITE PERMIT EXPIRES _l