HomeMy WebLinkAboutBLD2011-00125 - BLD CD Environmental Health Review - 2/17/2011 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH RE-VIEW
Mason County Public Health Official use only-fZ4 ow
415 N. 6th Street Permit Number:
PO Box 1666
Shelton, WA 98584 Date Received: /
Shelton: (360)427-9670, Ext.400 Amount Received 4 20 o4
Belfair: (360)275-4467 Ext.400
Elma: (360)482-5269 Ext. 400 Receipt Number S 9011 �8T
Fax (360)427-7787
Applicant Information Type of Review
Applicant Mo-r`bZ S-la-4ytenS Date )5- Building Permit
Mailing Address 127 .80 M6S )0_Y1 CAfde- ')Rr- New E3 Replacem nt
tpo'_�"oo 9R370 O Commercial Building Permit
City State Zip 0 New 0 Replacement
O Building/Commercial Pe mit Revision
Daytime Phone 0?79%z73pther Phone36oy�byo2� 0 Tenant Review
E-Mail Addres p Pre-Application
Parcel Information
12-Digit Parcel Number �I a 3 a 015000 2 9_7
Site Address I q 0 N� < b 6 vp—
Street Number Street Name City
Type of Job Please submit a scaled lot plan
Describe work e4 z� u�/ - � showing all existing an proposed
building, on-site sewag system,
Number of Bedrooms 54 r o — / and well.
On-Site Sewage Information Water System Information
,fa On-Site Septic System 0 New existing Plumbing in structure? J<es 0 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 (Asbuilt). Documents Adequacy Form.
for both of these requirements may be on file with Mason
County Public Health ther requirements may apply.
Applica i ure /
Date a" d a/ /
Official use only
Departmental Review Approved I Denied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
Revised 2/17/09
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