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HomeMy WebLinkAboutCOM2010-00027 - COM CD Environmental Health Review - 4/26/2010 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW Mason County Public Health Official use c my ) 415 N. 6th Street Permit Number: I PO Box 1666 Shelton, WA 98584 APR 2 ^ 2010 Date Received: 4127/20/o Shelton: (360)427-9670, Ext. 400 Amount Received $2-6& . O O Belfair: (360) 275-4467 Ext. 400 Elma: (360)482-5269 Ext. 400 Receipt Number S7oZDl/O //S/ Fax (360)427-8442 I Applicant Information Type of Review Applicant) 1. /, .1�ti;s d�PMZ 't Date 'Y- 6-dal O Building Permit Mailing Address Po (it 0 New o Replacement t�4 --(; V N-04 9� S Z { ' Commercial Building Permit city o State Zip New O Replacement 360 O Building/Commercial Permit Revision Daytime Phone-731-7(y! Other Phone 2-25-54 0 O Tenant Review E-Mail Address tic- © p Pre-Application Parcel Information � r 12-Digit Parcel Number (z:?3Z — 50— 0006 Site Address r� 13e ttd%l�ss�6/ Street Number Street Name City Type of Job 42-6 a �' Please submit a scaled plot plan showing all existing and proposed Describe work Metz ( 1�^ �l� ' Ci building, on-site sewage system, Number of Bedrooms -� and well. On-Site Sewage Information Water System Information pt to W.o' ge corn✓>c/..n � JI On-Site Septic System O New 13 Existing Plumbing in structure? esO No O Sewer Name of Sewer System bQ IT& '`n If yes: Gt -T=, PD✓ i d, i Using an existing on-site septic system will require a current Please submit a completed Water maintenance report and a Record Drawing (Asbuilt). Documents Adequacy Form. for both of these requirements may be on file with Mason County Public Health. Other requirements may apply. Ap nt ature Date Official use only Departmental Review Approved Denied Notes Water Adequacy On-site Sewage System Tenant Review Revision Revis d 12/17/09 i�F 1 1 [ tt frpp Z 'iiJ r N It P i � r ?j' Iil jIF \ \ rw Y Imo{--_---- \ i \\\\\\�+., .r •��t`g ..—, i--s pp � I � / I � it wil 1-A o' - i I- EE i 1 X