Loading...
HomeMy WebLinkAboutMIS96-0695 Propane - BLD Permit / Conditions - 9/26/1996 MASON COUNTY DEPARTMENT OF HEALTH SERVICES finviron mental Health Water Quality Personal Health PO BOX 1666 SHELTON,TA 98584 LOCAL(360)427-9670 BELFAIR(360)275-4467&4468 Application for Determination of Adequacy TOLL FREE 1-800-562-5628 FAX(360)427-7798 Instructions ---.... . ........*........................................................................... ............. ................ . ...... ........ . .............. ...........................--..............................%...................................... :jfi:::: .......................................................................................................................... ......... ........................ ..........A............I.............. ......... ..... . .............. ....... ........ ..... ... .... ................ ............................... U............ ... ic4 .......................... . ....................... .................................... ------- ............ . ....................... ............... ........ .................................... .............. ......... . ................. ................................... .............................. ....................................................... .............. ... ................... . d .. .......... ..... .... .. ............... ....................... . . . ................................% X.;.................... ...... 0 .............. ........ .. . ...... ..... ......... ...... ...... ............... ...... ... ................ ........,...................... ....... ....... .... . . ......... ....... .... ........ : : ;'.' "'V " ..;..... . ................ .........................Ir n XXXXXXX.. ............... .......... ............... ... . ...... X ......7-X., T ................................... ...... ........ .Y M. ... ... . .. . .................. .................................................. ........ .... .................. ............................. .............. .......... .......... ......... ....... ............... . ....... ........ .. ...................... ............................. .. 3-::.... .... .......... . ............................. .. ........ PART 1: Applicant/Parcel Identification Name of Applicant (\ T7Z. -L I &C ,ate 6-1 D, Mailing Address k-0 6V 40 ULAN-A LO t Telephone 4D--7-A Assessor's Parcel Number T vpe of Water System(Check One): Reason or Application (Check One): 13 Public/Community Water System(2 or more 13 Building permit connections) o Land use application,if so.. o Individual water source(one connection),if so.. 0 Division of land Well #of Parcels? Spring/surface water SPH9 - 13 Other(explain) E3 Boundary line adjustment E3 Other(explain)_ U-0 ct;-, PART 2: Water System Information, Complete the section appropriate for the type of water system being evaluated for adequacy: Public Water System Name of Water System Water Facility Inventory(WFI)Number: 0 The water purveyor has filed a letter granting blanket hookups to this water system 13 1 am the manager of this water system. The water system has been approved for services. There are presently connections in use. This will be the connection. water system is able and willing to`pi6�9,6`water to this(these)connections witho—ut—e—xce-Rm—g the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date w-7 H.VWDATAURCHIMWA7ERAD3.WP Update:October 20,1995 IY i Individual Water Well o Water well-mTort(attach to.application) Depth ft 0 Well capacity test(attach to application) gpm gpd Well capacity tests are often peormed by the well driller at the time the well is constructed Test ,results -om these tests are noted on the water well report. Results from these tests will be accepted If the water well repore cannot be located by the applicant or if the water well report does not have a capacity tes4 a weU capacity test,which provides stabilization of draw-down and recovery data,must be performed by a licensed contractor. O Satisfactory bacteriological test(attach to V008tion) Individual SpringlSurface Water o WDOE permit(attach to application) o Method of disinfection a I have reason to believe that this water source can provide at least 800 gallons per day and/or provides water at a rate of 2 gallons per minute based on the following observations. AUTHOR OF STATEMLNT DATE RELATIONSHIP TO APPLICANT In addition to providing the above statemen4 the applicant will need to arrange an on-site inspection by the health department prior to determination of adequacy. Departmental use only. Do not write below t�is line. ••r.,vt,.:.:v•••• v v :::::::•:::::.:�:::::::::.V::::•::::::.v::::::vv::.:v'-.v.%fi:4:4%ti.;.......}>}:Y%Y:iY}w:.%•} ...... ................... ...,r.-.{ ,. .- a .. ......... .f .....h.....•.V.J:,:..:v:4:a :nix:::r::f•:v•:•:•:3.'�::'::'ff..::::••::.-: 4..... /....`.v.. _ F•i>v>}:4:-$.}a?::n .:{{ :yr•a>:i J.. vt}:?.v:r.v h•JJ{:i:{41}.v:,-:::.:::..................:nv:v{::.v:n....n:::::...�4n\•h•}:••.hvw::•.a w:v-$:.v:..r.. v:.-:f•::{?{v}JJ:{.:nv:v}i}S?}:}}:WnV... ..n.-. ... k.r.....- ..v•}'•h•::: :CY>:i'.:::::::•.v Y•n f}•v:.`SvFi p:w::::.:v:::::::::nV.:v:.v::.•f.Y v.:4:nr-.v ... ..4.J...:{: v:rh:':t}?}%•} ..%.}f.�.Yi}%6•x?!+.}i{}:4Y.. ..f.......... J v r..}....... xr" •. }:{?::}{$}:?••:J.i•n•.v{•: f.+::?irN.ri:s}.tw:.:{:x{J:.v.:w:.v::nv�,iiti•%t:Y3t:'{r ..{ =" :::$R:$i•:$"-::::y}r n•£ , F.f.. .;}..:i}:::r•.wv:•::-.'.-.'•:.. .ti,:.{.... ,.• •:.J .'v} :::}-x{v.:,,..tp�K:} 4>>,�oc•:•` ,'{p. .}ffi:•}v%•}:J:•}.Y%fi::..•.......:.. ..{.:. .> :S• r l..:sn} 1t:,':::?y_ {{•$} f-..-...-k`:C. .�vh4 .-4 k$' :::.{w:•.::vn•>$ {tv v.:w- .}...�{'.+i'•$hC.•.-r::•.t-'>:G•r;#•r, hti �.?�.�. .,`YY..�?•`!:$ :::d:? �• . •- r:.�, :': }�:nr,S:$:• KrS:dt:r ?Iv. v,.{:r••r<':'�.,F ,✓.{i '}"?rr}: F {C..r :::'akr •'h:. .... } $ x%i+:- •r v:i'?•JW... xi}•: �.jt,• iFi• ..r:... :xri+{:}•;::%:$v`;:���;i.•,w}'� +r:. .:a.: •'J.Y:.::••,Jt{fzq:n:}}}}'+r?}Y::.}>-:,..t:,-S},4,•`.y K..•?,.!• F`r '. {:::::: wr..��'f+f•���`�,,t'-,.v',x'r:a: .:ffi,...: !o:{.}f:•??�rP..y'::•:ich .:nY:,•,✓);.}:::at.::t:::}.:fi:::•}•::{{.}.:;r.•}F.:;•'r`.:'•:: .,•J ::.2:..3.•::•:h•}:•: :::•::}.......t:.:::.::::.:..n t:..::.n........t ��j+^ r ......t.n4:hf•• r.:.......t.. .}•........................x:::::nv....w•Ynv.••:::•}x::J-' v:.rX kr. ..: .,...w::n.nv.-._:.-.v.-3ti•--. ! :q:•x }+C ,.•J.+ r�p ..'x, .:S•;vf-.FJ:, .Y:i;l ''. $:4Y.. .v......v`V,v,-:.V:::rr:'F.....C.•. r .r:fr::::-YY:}:::.V::•::::.y:::::.}}i}}}.}}}.::}%n'-.v::.Y.•ni}}:;- ......-'Y}`' "r'Yx.V:F•{,;. 13 .F...n:v::n.:::::::......::w::ntvnv. t.' f` + r?'.$.,.•. .,, K.t., :n�..::-•n{>::?::e�:>.. :$..�...n...' :::::::n•:nv:::::::v.n- ..:.Yr •�n:.x. .vw r}-.:.v:;}::v::::4v:.'>}}>}:{av:::n}w:::.}:-:-:•}:•}::}:r•.:::::f•$•:t�}' -�' -}:�h!-'%:{{{:'•:{t{:i-:-=:-:i}} - .\•:::•$:aY: ...:...........................:: .:r:r..:..:v:rt1::•: :.:•: - +"v: :.;., f .$::${}}}}}'.::::::• ,!�•:,• .{?t.'•v ::x.V,•..:}}?}}i}: ::. > ! -. . .}- `::::i!•n.}}}y:}}:•:$!}i)::(v${$$;is$::::i::i::i::::::.v::..-a- n.. .. t....t t....:v-: f+ .{..n n..v.:v.::Yk:•} :-}:iIl :• �w>. � f :::J:;•:a>:•}}}'•}%•}:•}:fi:•:•;};:i?•;:•;:.}:•}.:-.}:{:s:{::: ............r':<. :2•:aJ::::::}:}::::•J.'t a'.}J:?•ui ::.}:•:Y<•.}%•}: .f•:}::::::::::x: nr•................................. .......:x::n•::::::::x:.:.:I.......................::::: � `Y ...•-x r•...t......n:a.::•:{w::. .........x:::h:•:n:::w::nw:n:::,•. ...xr.r:.:::{v::}...m::.V::::::::::::::::::.v::::::::::::::::::::::mw.^::.v.4i}$$}}}ii$}$: .............}.............::}::::}::::::.Mh,4:1:::::. is:{,:$$::$$$$${$$$$$$$$i$!{i$$C:$iiii':il iii'rji$iiiyjjjji}ii:::Y{:i}iii::i::+i:}:i:::}::>i::}}:a:•}}:fiY•}>:n},v,4};:•J ...................................:............................: by :::::..::.:n.:::n::n•.::::{:::.:.:.::.:::::{:i:::::._::.v::-rn:-}:•%.;};r{?{{{::::xr:{}.is4:{ti!fi:•}{{4J:.}}:av:4:{<{4}i%{-}5Y>:i4}}'4'::i::na:}:::$Y}}S}:-J}$:!$:4:?v?Jr1;•J ...........................r....................................?.....::::::::r::•}:{•5::::::::::::x::::::.v.v::::::::::::nv:::::::::::v:4:4:{•ii{ti{Y:::4:4i:•}Y{:tin'v..^P rii'>u'.V v........ ......n.. .'�::•}:":ih ..............v::::::nv:w:-::::::::::::.......:::v:::::::::::::::::::::::::.v::::::::nv:w::::::::::::....::-v::::::::.::_::::nv:nw:.v:nVx:.}::nv:k+• K}i..$i:-}}}}!$}}:f{v}}i}:4::$J :t.....::Y}:Y:4:4:•YaJ:{.}:{•i:n:w:::::::::...........:...n............v:::::n.............•• t:.:nv::..:.{vx:•v:n.:nY}:•}:::{:•:vnw::.�:._:::n::w:w::nwn..v•:.v:;,••.•. :.$ n........ ... v........ 'i :::::.::4;:4v-}:'.}}:..:... v:nV:•:xxY:............. .rr..f...........r.............-......r....-.....:......}-}. r .. - .,... :::::::n.n::..:.• ::1[:.::{: .:;..:n.;...:.:.v n:It:::Fn;{{: :.%:{h.'/.••.4F:{:%{>.v. .../•'::.:4}•:.; Vy��y} MA •.v..M::•:.........A "ixr }$}}n;•'ffi}}}}}};.}i}:{}f.• J'{:} v: •}:4;{4}}••}}}:•}:i.:}>}�:{v.v ...fi.....r.....x.. ::.{.::::::.vv::'-:.::{'v:J .vJ`'{7,�•�:tiJ`:•J`J}S}:•:•.`•:•i:v}:v.v}}}J}}:n}•:•.........:.......:.:4:!•: ..%?. ...'h\}:•:Y:tiu{iii rJ}>}i$}$}y.'r n}:{?ti}rY�'�$$$$'•:?'.:::$::::;::$J+�: }J'•:::{S}i':}:S:,a,::�{::}:$i�::i:{':-}�} 4}}:G:G:•}:?ifi;•}:{•}:4}}:{{?4:•}Y'•:J:: V:hv:::::::::::-::vn::{:v.{:xF t}••y::.Y ........................ ...........4..::::.:.�:::::::{{.}:$C}?:i r:�:.•}.!.; r .. .. -rxlf is•{'{+.:: ... v{ :$$h J:a}:{a:.}:•%•}:• .r.k;:.}.':?•};:}..n.:.... %y:::YJ::•;v:w:v::::..::::.:vv:::::•..r: ...f•. :{:}:?'2:}${$at:}f,.x`itirF.-ri'2o,:.,.. t:•}., jt{. :rrr-is{-:vvr...1 K nk.:• {{4}•Y{{:::::::::.::::::::::::::::::::::::4-{::::............r.Y' w::.Vx:::v:, t,. r.1::n•:n!::•.,v.v::n;•:nw:n•:n{• -•: ..:?k.�' ;. ....:-n.nv::.........w::::::-{•}}%.}}:{{-::-:}?}:•},}}}:!{?{•%4:{•:v}:-.........:...n$a.. .S'J..:G.iY}+.. r.......................................:..... .Sn...-Y n+t.:::n ''V'?}'•?S vh,...xv :,v:\:<� :::..:...:::::::::::::::•}:•::::.}v.}v::::n:::.•n>::V>}'..r-.r.nr:.}w:Y.::v:Y•:::::::r::n.i {..... .. ...n.,�fi11'.Sr,�' .:•:F, .J;:{}vnv v.f,.. .4. :•:J.....v rJ:r v:w::::::::::::.�-.•.�.-.-.�'•.'�... rii. '•� nnk?J�.-'•kY•.. ......................................mv: n;...x:::n: ::::::::::::n:• t..:::r•;ty::::v:.V::::::.V:v:::,V;.y., :•:t...r. .•, .............. ?•$}rR:22`rfi:>y..;:fi•{.. iJ$':Y$i$}{•:k:}f - .Y�}•'•: :•yf, 4� :�'F vr,::?:-:•• •<},'?:;•'•`:•{c:•: . e to ::. ....:n;•:.v:::.:............:h.r.M.•k:::.4;•}'•}:.:{.%.. {.}}K.}Y.:fi;+. K{r..:.:{Y:..� ::. ,'ti;.}:.%;.,`v$:?.``�v\:.:•}:'{.}: .............:.�:::...................n.................r....v;}:::::::nfi::::::iai�ry:�`i:Fd:rrr:n}i'.....n...:.................. v,.?v•.•.i k: .... v.•::......:.............:................:... ::.-iv-•:n.::::::::::::::{.:::::.,n}.:{r•}'•'fi:::::::.V:::::::n:::.:n.::::::::%{v:•}:4:•J:4:4:fi$$:<•:.:$$:{i:•>:?{:vie -r•J•:Y$:•J 4N`.aJ.....................:........................:............: rxx:::f•:kfw:::v.V::::.v:::::::.�:::::.v:::v::::::.v::::::::::::.V::::n•..... t.:'{{•nk:::: ... ..% ....... :{t:•{,}::{i$$$$:v$::isi$$:::::tii:•}:{{{^}i::?-}{}}}}:•$:4%{Y}:•:Y}:O}:•}:{v}:4i}}}}:Yi}}}}}:ti?Y:O}}:Y'•%{•:Y}}}-:::w::.+v:4:}:}}?:}}::::::.�v}}}::i:::.�::::}::}}::a:4}}:i}}}}}::i:4 .•.'+ ?{:i{$".. .Yi'vrrn+:.y.:w::::.�-:::::,:.............................................n.....................r.....:..v.......................................................r........rt{ter::•fir rfti'mi.::}::{v...........:.. r..•C4. ..............................:v::::::..............:...................................... ..........x:.V::::;•:xf••}:•>:?•}:4:?•>}}}}}%:{.:}'v..:iw.v}:•?}:•}:v::{v':}>Y•}ii:4:^i}}:J:4::}%:::$>:}:;:yi::..::::.?:•${}i:{:>}.}}}..:? :. ... vi.:::$Y.r:•.:YYk:}r:v•. {.i::fi•{{n:;� ..................:..:.......:.....t:;•::...:v:-:::. n •.vw:v.r:w::J::::.n.....k:nv::.............:............v.v:;kr, r �:�:f?$$$$$$$:$;;$$${;Qyi:$'i?}:}:{$:V.}}:fi:4:4:?fi:4:G'•i;•:.::v: � .:::::::.:�::::::::....:.:....................:::...::.�:::._::::.:.:.r.r:::::::.:. .:................t.......:.,-:::.-r::r:ra.rk:. f{•^:.:r.:..$`} :•::r$....,fk:; r:.........................r.v}::::::.�}i}ii}isnv:::::•}}}iJ:4::>i}Y':;}}}}}•-• {• {v;v::...:.................:::nw;::;:v.-:•:}::•:S:-}}}i:{•}:{:{.V:v.v.:•:w.:.........,:..........,n,..n:••.:'.n.....................n:w:.n:,:.::.n•.n:..• .. ...r{{{::.: vy+:: . ................... •:w:w:w:v v::;..,...:x.:::-v:•::::....;..:x•.w:::::.:::::•.V:::::w::::::::: ::::::::::::::::nV::::.:v:::::::.V:::v: .. .,; •.: � •}:fivJ::Yf::n:n:::::.:}'::{{n%:.}'ai':.v:::::.V:v.:?:{:? .}:::n::n..rv.:i :F. .:.v.................•tt{:i:::::::::nV•:v:n•;::::::::::::::.v:::::::.v:::::::::n:V:n•:::::;}:i..:.n... - ?}n' $' .} - .':•••v.••f.4}'{a::w::a}}?}}}S}:•}+}:}}}}?:}S}?ii}}:{.}}}S:•}:4}i}}i}}}}}}}S}'4}i%4}}'-}?}:.?>%... •Y•}$}$}:{{4•v: r 'n... ;.�. .�Y. •f :Y}:•}:}::4::a:...n..................n.......................................r........n..........}rr:n �� ..........•rF.Y•:iY>`,in}%iG:{4:}}.vh•.rn...., H.-WDATAURCHIMW,42MUD3.WP Update:October20.1995 a�.. va v -c a v o v ,� c .. -� - cis W -n � c.. WW o 2 �- r > m -1 -4m m m W_ Cncm m > n► C - -Y 1` C"i -4 A A Z t) o -4 -! > -i f1f -1 > Ct rn x vir -i � � z a > O -4W -tL0? z0 _ - $ -. -- r WWmWW -ai -4z °QQ' -Tt � a _ _ � m mwmfm » ' m -! w 0 wow = WW a 1s .o► �. 74 =t w 0 a � o m mmmf « 'v 00 > r Rn W Z h a © -f v m (v p ."" • z > pOL ° o = m m = C l = 0 M - 60 v � CAQ -# d • E W m _ co m } - © A -1 4 t.- W ✓ .30 m x � - �y 09 = W r n W �D r � i CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas piong date by FOUMIatbn Walls date by Set Lip date by INSULATION date by BG/SLAB Irmilation Floors Final date by date by date N Q Wails FETE DEFT. data i by PL.t (i date z- _ TM R Attic date date by D.W.V. e by WALLBOARD NAILING date by Water Line FINAL INSPECTION SL�� date by dater)„ date by I i i x 0 f+ - -4 x > = Q> v V ° m 0 — = zr GoMm 30c a. Ana m c 00 m ca w m r- c - - - 00 A 0 (A a -IM > > *+ Z U _ptio � � = Go �' - 3' a� 8 rn p .• •+ ae < auswimx a CO) -4 f" W "" • ,+ ar 4 m = 0 .. IF 000 OZSfu © C z I 3 4 R_ M -- -4 p -- Z (' f+ 0 0 t �'91 5s -1 � 7D (/) •- I{ 0 z r- 03 0 m 9) 00 W D oO rt ... I" A CA Z A z (p au ` / j' — 0 O — ` ' 0. 0 00 yam. -4 c 0 so OM mm — �7 ei C W0D !rot! > Y ? �k�I � � t 0Cz Z7 ` Ze on $ Z > -- U1 � I 0 z 9 -4 Ix z In t� Z I. a pc -cCOM tv CA) M• 0 V sa C m - as 0) - w r, r, 77-1woo K 0 -iQzwc > r- psi y cirQnvt ' = 0 _X -i a to I 9+ !' O $7 ? tv Ea #Y3C vi �► w Go X 03w m O a r -� -az rr of 9 > try r f+ .► � -� c� — > a --4 -40 _ m Cl) — w 0 rho r► 2 -i 0 -4 � O O C 0 tea x Da 1"0 a a $ r. CIO c0 _9 i c ♦ J r — m ca9 •- 0 a � ? a = CM = 0 a .. a I .. a . • ®0 -4 s - x c cm 00 -60i CL S .. 10 0 o x so •s ao Q Q 00 - m .s+ = C'oc z - CO) xC) o � a ° Q a __No O J r is =z s � � z p s —0 .. N as t! 0 -3 0. =r Zi v ra —ex a I �f D a Q * s +c Of Cl O c — I rd IQ lb c so No c N I ? CONC � C 60 m II f x aNOCI s co Q I f' n 03 _ 1 _ I 'I Building Permit # 10 MASON COUNTY BUtLqING 111 426 W. CEDAR SkLTON, WASHINGTON 98584 (360) 427-9670 1014 Job Location O — AV �Q This ire Data been inspected by Mason County Building Department and ifs Mowing VIOLATION of County Laws and Ordinances has been found: dip XP'p,ev vX_0 ,�L��s o•� .sr Tom : -Items listed below must be corrected to gain code compliance oX S7ACA < 1 �� f�,C�1t?.C•¢���� 01JiCz' � C'T,<<cr�f I�iQ..t� N All AW 1c 3 L4,4cf/x--- All 7v.B5- e_r 1 STiYi� Ile t S�Csz OJ� ICr�49 - �it��1 � d.�,tL � Pao�Toeumare hereby notified that the above corrections shall- 5 be madeE:h�ORE PROCEEDING WITH ANY FURTHER WORK ma' s ������ d� ❑Call for re-inspection when corrections are made before continuing 4 Make corrections, items will be checked on next inspection ! ❑OK to Department i Date & Inspector—Z>zf!r .-