HomeMy WebLinkAboutSWG95-0103 - SWG Application - 2/28/1995 . . ;
—"--, PERMIT NO. SWG 7�T.r Cj 15 rn r
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MASON COUNTY DEPARTMENT OF HEALTH SERVICES � - � - � �
426 W.CEDAR/P.O.BOX 1666/SHELTON,WA 98584 Data [� l.D y`-_.. o
PHONE(206)427-9670 Receipt No. — z
Amount$ m
PR P RTY OWNER: 7 DATE: a —Jj-- /J CHECK APPLICABLE ITEMS ✓_
(0t U_F-1-t it, S t f 1_c4-c u via. — -- — .
MAILI r�• DD S: YTIME PHONE: INSTALLING NEW SYSTEM a-
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/S j�Ci REPAIRING OLD SYSTEM
CITY: ),S„TA�TE� ZIP: - ESINGLE XPANDING SYSTEM_ _ fit
� Gl/ — _I QJ_s_Z9^U' OTHER FAMILY --- — Z
PROPERTYP&RESS: —
SPECIFY: __ 3
SPECIFIC DIRECTIONS FOR LOCATING ITE: 'co^n 1.5c l•r,•r' t c•t•t t PRIVATE WELL l/-_
,,,,L�C •�- PUBLIC SYSTEM ___ I'
�;i_N t�h w ait7hG N• har c O CA t\r1l_� J�1 t OM_ SYSTEM ID NUMBER I"'
4 ()ne1S,T•,rn r`teht iv p tr,or• -Trth...in ad. Ctjc 4Cl4tr SYSTEM NAME I�
t ti.vtr,l• otv f ht. (lrr_rh Sid•B rp_1 qke Lt Y?1-rx=yP-T-r34�t A PLI ANT
Q7lrr LwS,n r tY�Q A C� '1�J,/m I C 04 1 0 �r e p l�� I NAME iLkZ --_ — )r I"_
Nameof�i�)(Ifl-:%E' rt,// ( <-,)1( riot(• �`'AH .( '1 .(t.x��• I< •,/,`•41 MAI NGA ESS__ ff;;� /
1
Installer i, _.j. C' a'. LL S L__ ft - p I
Size: o�SZ acres TELEPFI. E_-L_--: )__._ s. IJ
Name of um er o S ' J r o
Designer Bedrooms X etA S f/ zit, �' ti,"
PLOT PLAN _ 30' --As tr7+T7 - ��� ~^ !/ 1 ,
Draw a nsional plot plan, Iv
includi +I tt rl 1 0-
ID
O Prttion of tesllf� / \ I I ( c, 1�,
h01 wing ) \� k .'Ar,. ri I�'
me disipgcesht.: t 1-15 \\- ram;` l,i I c<6�n��t,.c.1
pro twur es. ID
I * ,,,v, `
O Er�y{,/Qpad:other watt L1 � '-�
ET fp
drivtlnkbys• cv 0: I �'�7�t ^J
N /� S SifiEM DEptaN I //
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4 IZr lll,t_ 1�,L,,
VFFICIAL USE ONLY.DO NO�WRITE BELOW DOUBLE LINE.
SOIL LOG
' "1-. 0-3 A I' ,►2d 1ôin OU4�� I1 r� '�11. �cY 7�; `1/, ),01'
p1-.oue t_?1 t Ii 60 l 1 rani"to-ilev,
Depth from Original
Grade to Restrictive s
Layer or Water Table: ''` in.
DESIGNER DESIGNATION SCORES MINIMUM SYSTEM REQUIREMENTS
Findi Score Designer Level: U One JkTwo
Soil Type �7 2-t
Vertical S aratiltr,=�a7 In, �T Septic Tank Daily
ep �v Capacity: il 1 1 Gal. Flow: -%/ it' GPD
Slope •---� 9t CJ i �! ✓�!�V
APO. Infilt. • r
Parcel Size L i Ac ✓� Rated(� GPD/FT' Area �j(J�/ FT'
Distance to Shoreline r-J-1— 9 l TotaL/•T Inspector Date Al
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COMMENTS/CONDITIONS FOR APPROV Li q !
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a° `91.7(16 (bde re4-P,I-A lie5 5
4e(/77 / 'ej?pz cu 5)C ✓ 071 N O D t C'/f: e4/7,,ep i'
of
Any change from the specified use of the property or any site alteration affecting the system design may Invalidate this permit.
This Permit expires 3 years from date of site inspection.Denial of this permit may be appealed to the health Officer within 10 da s of denial dale.
•O•.. .1 r... •*^T ■ 1. DESIG o •..roved ❑Not •• INSTALLATIONS Approved O Not Approved
BY. 1►1 1,,'y DATE: BYE' � , r DATE: 2 i1.1 BY: DATE:
TOP:Health Dept.Copy (•MIDDLE:Designer's Copy BOTTOM:Applicant's Copy