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HomeMy WebLinkAboutWEL3527 - WEL Application - 7/1/1973 / z THl'JRST -MA50 HA TH DISTRICT �j & irch,'P.O. Box 746 6 � _ S� / F!Shelton, Wash. 98584 I N OF ENVIRONML HEALTH Courthouse Annex ne: 426-4407 C,� ok1&t Olympia, Wash. 98501 Phone 35��857 =T 84 (QodNER lot Ln L �� V PCB rr6 PHONE '�45 6 oZO� OWNER'S ADDRESS 98� (� C o.Z 9A CITY 1 e_ a e. STATE SEND REPORT TO L3p 5,�j CITY e_f STATE SEWAGE CONTRACTOR �arr ADDRESS ' (If self, confer with E.H.S.) I LEGAL DESCRIPTION r d QG4 '72 / AECCO/ PARCEL NO. LOT SIZE 747 h 4�00 r INTENDED USE OF BLDG. NO. OF BEDROOMS N0. OF BATHROOMS BASEMENT PLUMBING: YES NO !� NAME OF WATER SYSTEM INDIVIDUAL VII PUBLIC/ COMMUNITY DIRECTIONS TO PROPERTY: (Be Specific) p '�� `516'^G 114 rt, 1�t rpK, m t je �e LI� V @6qJ4?,_to Pa r r�� - a1 - 6 DRAW A ETCH SHOWING: 1. Property lines, location of ho,,.se on the lot, and dimensions of the lot. 2. Location of the house and sews a disposal syste in relation to streams, lakes, wells, lei soil log holes, patio, driveways, un,d d ks, ate supp lines and easements. Cut 0 tt p— 04t dJ (36,C7 —yo Cl n �� � 1 E ,.g b �P The septic system is an appr-oftS temporary metho o sew Yb V'e - dis osal until. sanitary sewers are available. DO NOT WRITE IN THI$ SPACE jtyu e �.�� � I `p 1Y14d y'� %rI 50'`h Teo tare Oil Oil Jee���a V MINIMUMS: C ��ecowl Q Wci c��n p A 1'4K fts Septic Tank Drainfield'1 b�,`Sa �© ►`�t`ec,de � Yh, , Pi rrq C�-��dI I b rC JQ O ee �rdra h 5"t c -to o 6e'1�v�ei c�e veJ a n 1h0 CX4 0.V_ th.in (a( V's E AP LICATI N ,y APPLICANT'S SIGNATURE DATE SITE INSPECTION FEE CYZI>f NO.0 B APPROVE NOT PPROVED BY Date Date -- Inspec or/ - -.._.! SEWAGE APPLICATION NEW / / ALTERATION APPLICANT'S SIGNATURE DATE lo- FEE -/-_I p oo RECEIPT I 4BYPERMIT N0. APP . ti ROVEDY Dat Inspecto .H.S. U ;l I 5 SEWAGE SYSTEM CERTIFICATION Property Owner Address v� S Sewage Contractor J?,o /h Date /f 7 Parcel# 1. Scale: 1 Square = 10' 2. Draw in physical structures to be on lot. 3. Show location of well or any body of water. 4. Show location of septic system in relationship to structure. 5. Assume an elevation of 100' at one lot corner & indicate the other lot co elevations in relation to it. 6. Use Arrows to show direction of slope. 100, J ' r" -c. Septic Tank Volume . , f" fc, f Drainfield Length I. Cubic Yards gravel used I certify that this system is installed as shown above, and that all- requirements and standards of Thurston-Mason Health District have been satisfied. Signature P,�Z �f 2 Contractor's License # ` June, 1970 � SEWAGE SYSTEM CERTIFICATION rtY der � 'ri,p�L Address �� eContractor 7ZO Parcelg, # 'cale: 1 Square - 10' raw in physical structures to be on lot. how location of well or any body of water. how location of septic system in relationship to structure. 23sume an elevation of 100' at one lot corner & indicate the other lot corner Levations in relation to it. 3e Arrows to show direction of slope. fi O r 1 i OD Septic Tank Volume Drainfield Length Cubic Yards gravel used. T yam_ I certify that this system is installed as shown above, and that all- requirements and standards of Thurston-Mason Health District have been satisfied. _ . p Signature �i>`f Contractor's License # 191