HomeMy WebLinkAboutBLD2010-00646 - BLD CD Environmental Health Review - 7/23/2010 COM UNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
�° Mason County Public Health Official use bnly
415 N.6th Street Permit Number: —Bld 6143— Q�LU
PO Box 1666 -7
/ Shelton,WA 9&%4 Date Received:
Shelton:(360)427-9670, 6d.400 00
Amount Received
Belfair: (360)2754467 FxL 400
tlma (360)482-SM FxL 400 Receipt Number
- Fax (360)427-T787
Applicant Inforrnalion Type of Review
Applicant Dater7-2340 k Building Permit
Mailing Addre _l 0-6oA o New 10 6
placerrient
71?>SI F ,uL. L1A 4a52S O Commercial Building Permit
City State Zip 0 New O ReplacIment
3(� 3 O Building/Commercial Permit Revision
Daytime one f13A Other Phone
O Tenant Review
E-Mail Address O Pre-Application
Parcel Information
12-Digit Parcel Number CQa31 1 - -1(o - COH Sf)
Site Address I i-I to I r)e- t aeg, - V&- --e*j WA 9 6528
Street Number Street Name city
Type of Job Please submit a scaled plot plan
Describe work ) t �O Mc showing all existing and proposed
Number of Bedrooms \3 building, on-site sewage system,
and well.
On-Site Sewage Information Water System Information
Er"'On-Site Septic System O New 134 n Plumbing in structure? 6 5es O No
0 Sewer Name of Sewer System If yes:
Using an existing on-site septic system will require a current please submit a completed Water
maintenance report and a Record Drawing (Asbudt). Documents Adequacy Form.
for both of these requirements may be on Me with Mason
County Public Heatth. Other requirements may apply.
t a
(� Date
I
Official use only
Departmental Review Approved Denied Notes
Water Adequacy �caCe
On-site Sewage System 3 10
Tenant Review
Revision
JAI()l/ AlgCe dim
APPROVED
MC PUBS IC HEALTH
AUG 0 3 20i0
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