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HomeMy WebLinkAboutCOM2005-00097 Bury 3 Septic Storage Tanks - COM Permit / Conditions - 10/19/2005 0 2 X0 ? 2 ± 2 n a 0 r a 2 CD \ \ \ \ f CDCD < CD -0w 0 cin � i ° « � r- k x e 2 m t \ * \ q m % % J £ \ \ \ / 0 \ f ® o ( m o / \ � \ # # t � \ ® r- / a E o w IQ m O 2 > / 27 \ kk \ � 2 0 � � $ 2 / \ % ƒ � § 7 - . r- M \ / ; 03 m \ m g 0 m 0 \ cn CO. \ ° . . . r n c \ ¥ z X @ X X \n \ � k ® G %CD zz $ 0Z j a > ° @ ° � = w o 0 0 D \ 23CD ] m § S / \ f � = ) w / 9 = AGE / 2a II 00 0 a a C / f zcc 0 ¢ r / \ $ � Ul \ n 7 / 00 § r o n m m 9 z m m 0 I / \ / % \ q a %2 00 � J 0 > k � U) � � O c � 00 � -0 U m � � 2 � 3 E 2 . m 0 > 0 CD ƒ n � \ p0 m w z X Q / / w m x E 00 a m •• 0 00 to { 0 ® A ? 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PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton,WA 98584 Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT I FOR ATION CONTRACTOR INF R TION Owner DE �lLr Company Name a ' a - 1NL' Mailing Address.—AD, SoX Z3121 Mailing Address j2,o, &K City PLA4 A f I Up State OVJ, Zip Code q-R 3?3 City 1 I via State W . Zip Code!j Z 3 7 3 Phone 4 231 Other Ph.21'!o ` r-ta(czu Phone 4/ �Z Other Ph. Lien/Title Holder Contractor Reg. /16at C C G Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Fxisting Septic &A/ Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No. 22 -' - D Fire District Legal Description i +7hE r •2 2 &F W Site Address (Please include street name, street number and city) BE O-as I AI. � Directions to site r2 " < ` A(30 1-tie Q . Will timber be cut/add sold in parcel preparation?Yes/0 Is property within 200'of Saltwater _lye Lake_&& River/Creek iYo Pond &,0 Wetland NrI Seasonal Runoff__,p[Q_Stream ND Slopes or Bluffs > 15% 40 Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOWNew Add Alt Repair Other P IMARY RESIDENCE ❑ SEASONAL Use of Building Describe Work G ENo.of Bedroo No.of throoms Square ootage- 1st Floors 2nd Floor ' 3rd Floor Basement 1A — Deck Covered Deck ther Sq.ft. &112 Garage Attached Detached Carport Attached Detached MANUFA TURED HOME INFORMATION- Make N/f1 Model lf Year Length Width Serial No. 414d —� No.of Bedrooms 441& o.of Bathrooms Type of Heat Purchase Price$ Replacement Uni . Yes/ o� Installer Name Certification No. OWNER/BULDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission fro them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is a u to d grants employees of Mason County access to the above described property and structure for review and inspection. PROOF O ATI OF �KMEANS OF A PROGRESS INSPECTION. _ X Date, y/DS Owner/Owners Representative/Contractor indicate which one FOO OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Ael 73 5 f Planning Department nv l5,41(� Environmental Health Departmen Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing& Base Fee Planninq Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal MASON COUNTY PERMIT NO. —PkA Cb Iy1 BUILDING PERMIT APPLICATION 426 W.Cedar• P.O.Box 186, Shelton,WA 98584 Shelton_(360) 427-9670• Belfair(360) 275-4467• Elma (360) 482-5269 J127 i On the web www.co.mason.wa.us AP+K.!;,ANT I FOR ATION CONTRACTOR INF R TION ` Owned • Company Name L' Maili Address Mailing Address Or r City. _State Zip Coded City State W Zip Code Phone Other Ph.23; ^ �&2.tQ Phone Other Ph. Lien/Title Holder Contractor Reg. Q46PC b Exp. { ` Email address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic_ Fxisting Septic Connect to Water System Name of Water System s Well Water System - Name of Water System PARCEL INFOiRMATION- 12 Digit Parcel No. �• Fire District Legal Description 6 + % • 14 to Site Address (Please include street name, street number and city) Directions to site ' • • is Will timber be cut/a cut/anfd sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake t© River/Creek Pond 41�o Wetland A142 _Seasonal Runoff Stream A6Q Slopes or Bluf#s ?'15%• 40 Is this permit submittal the result of a Sop Work Notice,Correction Noti6e'or oNW enforcement racoon?Yea/No TYPE OF JO*New Add Alt Repair Other P IMARY RESIDEUse of Building Describe Work No.of Bedroo o.of throoms • Square ootage- 1 st Floor • 2nd Floor3rd Floornt AJIA 4 Deck Covered Deck the0 r Sq.ft. VAd Garage. Attached Detache Carport Attached'&& Detached ' MANUFAqjURED HOME INFORMATION -Make Model Year Length WidthSerial No. �� -�� Nca,of Bedrooms o.,of Bathrooms Type of Hefit A144 Purchase Price$ Replacement Uni . Yes/No Installer Name Certificatiorf No. ! CV*4ER/BUL.DE R Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am-entitled tojeceive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from aU the necessapprr parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the applilation,I have obtained permission them to apply for this permit and conduct the work proposed. The)oWner or agent on owners behalf,represents that the information provided is aafurate !grants employees of Mason County access to the aboveidescnbed property and structure for review and inspection. PROOF O 71 OF;tff MEANS OF A PROGRESS INSPECTION. _ X Date:�jZ D5 Owner fOwner Re resentative/ ontractor indicate which one FO OFFICIAL USE BEYOND THIS POINT Acceptedby: Date DEPARTMENTAL REVIEW, APPROVED DENT D -,. NOTES Building Department a IG'S G 0 Planning Department tr. e� /f_ Environmental Health Departmen Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbina&Base Fee Planning Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES o►r�l ; o►o�'- o'00�7 MAsoN couNn LIGATION _ CpMPLETED INK LpING PEIRNIIT APP WA 98584 482-5269 MUcT BE gUl Box 186, Shelton, 360) E PRESS HARD 426 W.Cec 0�BelUfair (360)275-4467•Elma kS wa.us G• 360) 427-9670 co.mason• INF o On the web vim• Shelton ( CONTRACT CompanY Name '► OR T10N p �L� Mailing Address State Z APPC F City Ph ode _ �• LI -Z G other owner Code - '�� Phone �¢t C Maili Address fate ` Zip Contractor Reg• City Other Ph E Mail Address DOB Phone Drivers Lic.# Existing Septic 1.ienl Title Holder -- DOB Septic E ntail address MASON-Connect to New P Drivers C.# M INFORSystem--- Fire District SYSTE Name of Water ` EpTiC 1 W Ater s m Water System � W f •S to o - Ss e r am Connect to Water system ---N 2 2 • Water Sy it parcel No. well_— pT{ON-12 Dlg g PARCEL INFORM 1T t street number and city) Legal Description Please include strReet name . Site Address(please pond.— '-- Directions to re aration?Yes 114� River I Creek�j,� a d sold in parcel p p Lake" Slopes or Bluffs 7 SEASONAL Will timber be c Stream_LSLQ on Notice or o� RESiDENC properW wtthln 2 Se sonal Saltwater -- - yy . NotkxI CO- Is p IMAR Of a Stop nd Floor Wetlandm i�result Alter Repair Other . Is this Add e_1st Floc sq.K f TypE OF JOB_ New tG Describe Work ootag her Detached • No.of� rooms-1 Covered Deck Attached Year Use of Buildings �/�, � k Car rt No.of Bed asement.AFf '—p ached odel o.of Bathrooms 3rd Floor Attached _Make No,of Bedrooms Yes), °� Gara e E INFORNIATIO Replacement Uni . of MANUFA TUBED HOM Serial No• Cert►fication No. Width Purchase Price$ order or peda t1aam er►ui tD rece Is this th a stop`NOS parties.N P� Len g result in or.1 further Type of H a • of inaccu�e iniorma r tatw,or the c r n fk a0 tl►�the apples'1�infom�On Installer Name subn►s r owners leth r PNe work p�rrrop d��l TOPO is tl►at Kwiesthe owns that 1 have o . 1811 1 declare that I am man 1 declare Ong dais appl r or agent on re for revle`N n gnature be►a"r roped in the appl in interest regard The owns rty and structu mPe s�lt and is lJY to do theent MIder or any nd"duct the w ��aboSP sctibed p / wired fry�themto 8W� oyeees of M MEWS OF A PR�RESS Z Q6 pe.,rm.,', � u to 'pF W K pate Date pFiwr indicate`►►hich one tractor Accepted by NO,ITES X owners Re resen ON DAIS POINT S pYmer ow DENIED FO OFFICIAL USE BEY (= L REVIEW APPROVED DEPARTMENTA artment ( ° 1 v o 0 Building Department planning artmen Environmental Health D np rt public works apartment FEES Site Ins ection Fire Marshal EH Review Fee permit Fee plannin Review Fee Bull in Other in Fee Base Fee State Fee ittal Mechanic Base fe o al& Fee Pre-Paid at Subm Wood I Gas I Pellet St Ve TOTAL FEES `olation Fee MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W.Cedar• P.O.Box 186, Shelton,WA 98584 Shelton (360) 427-9670• Belfair (360)275-4467• Elma (360)482-5269 �`f On the web www.co.mason.wa.us APPUCA T I ? ATION CONTRACTOR INF R TIO Owner f Company Name, Maili Address Mailing Address Q, City �ip'C;de City State LdWs Zip Code 37-5 Phone I Other Ph.2.Sx3-y0r-k& t,� Phone Other Ph. '' Lien/Title Holder Contractor Reg. G !$►" Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic. Existing Septic ' Connect to Water System Name of Water System Well-Water System T Name of Water System PARCEL INFORMATION- 12 Digit Parcel Ni . * 7 «. Fire District Legal Description i # * o Site Address (Please include street name, street number and ci Directions to site ADM 60ATk1A1' 41 ' Ronot Will timber be cutland sold in parcel preparation?Yes/40 Is property within 200'of Saltwater 462 Lake4eo River/Creek At"O Pond Wetland AJQ Seasonal Runoff Stream �trd Slopes or Blu s > 15% 40 Is this permilt submititalffie result of a Stop Work Notice,Correction Nod ce'cr gftroinforosfr>iant 71t"JNo TYPE OF JOB -.New Add Alt Repair Other P IMAR RESIDEN SEASONAL - Use of Buildingf AW Describe WorkSaU No.of Bedroo No.of throoms Square Dotage- 1st FlooTther 2nd Ffoor 3rd.Floor sement-J—Deck Covered Deck - Sq.ft. Para a Attached Detache Carport d Detached MANUFA TUBED HOME INFORAAATIO -Make n//� Model Year Length Width Serial No.A � Na of Bedrooms o.of Bathrooms Type of H Purchase Price$ � ✓>1 Replacement Uni . Yes/NO Installer Name " Ce ification No. CyV*4ER/BUL.DER Acknowledges submission of inaccurate information may result in a stop work:order,oc]Jiermit revocation:Odaaowledgemerit of such is by Signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to rec eive this :permitand to do the work as proposed in the application.l declare that 1 have obtained the permission from all the parties.if permission is required from any easement holder or any other party in interest regarding this application or the work proposed in theme��,I have obtained permission fro `them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,representsthat the information provided is to grants employees of Mason County access to the above-described property and structure for review and inspection. PROOF O Tt OF K MEANS OF A PROGRESS INSPECTION. x , �c...' Date: Owner' Owners Ra iesentative/thiftactor indicate which one F 1 09 OFFICIAL USE BEYOND THIS POIN Accepted by: Date DEPARTMENTAL REVIEW APPROVED DEN19-67 NOTES Building Department F/C 7-0 Planning Department Environmental Health Department Public Works Department Fire Marshal FEES , Building Permit Fee Site l s ection Plan Review Fee EH Review Fee Plumbing&Base Fee Planninq Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fes` State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTl L FEES Mason County Permit Assistance Center Planning Intake Checklist Owners Name: (_�J�"c Grc C Date: , 2 1l,9 _S Project: S,� Reviewed By: Commercial Development:---DES^,NO Comments: Planner: GBM TSC(CM M SNG BJR Site Plan: North Arrow i Property Dimensions: r)�3 X _�3 v G Streets and Driveways Shown. Road name: All Existing Structures shown with setbacks—�� ❑ Well Location, Septic and Drain-field Shown with setbacks Identify all surface water(streams, onds,'shoreline,wetlands, etc.) ,zll�Topography(slopes) j' Proposed Structure Setbacks (Direction/Setback): F: / R: / S 1: / S2: / ❑ Utility and Drainage Easements: Yes No (if yes enter condition#5022) ❑ Other Easements ❑ Accessory Appurtenances ❑ County Access Permit Needed(add condition#0010) ❑ State.Access Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning reviews: #5019 and#0700 Are there any impediments that may restrict access to your site? (dogs/gates) Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: -Not Applicable ❑ Agricultural ❑ RR 2.5 5 10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ❑ Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT Urban Growth Area ❑ MPR ❑ Unknown ❑ Unknown Water Body(type of water if unnamed): SE A: Yes o Unknown Flood P ain: YES NO Unknown Map# Aquifer Recharge: YES NO Unknown Map# Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: YES NO Eagle Nest Tag: YES NO Other YES NO Addressing: Check box if needed ❑ Reviewed by: Revised:07-12-2005 I:\PLANNING\CHARELL&RENEMPLANNING INTAKE