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Get WA Request For A Health District Construction Clearance And/or Water Supply Comment 2020-2024

SEC 63/GMA Compliance Required? YES NO SP # / Plat Name: PDS NAME: Sec: Twp: Rg: Expedited Review Site Legal Description and Lot #: OWNERS NAME: PHONE: OWNERS EMAIL: MAIL ADDRESS: CITY: STATE: CONTACT PERSON: ZIP: PHONE: CONTACT PERSON EMAIL: MAIL ADDRESS: CITY: IS SEPTIC SYSTEM / DRAINFIELD: INSTALLED/EXISTING* STATE: PROPOSED ZIP: NOT APPLICABLE *If installed/existing, approximate year of installation Has a new onsite sewage.

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