HomeMy WebLinkAboutPAR2011-00002 - original in 12320-32-01010 - BLD CD Environmental Health Review - 1/19/2011 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Official use only 1
415 N. 6th Street Permit Number: qjg_�ol—owo
PO Box 1666
Shelton, WA 98584 Date Received:
Shelton: (360)427-9670, Ext. 400 Amount Received 5-7
Belfair: (360)275-4467 Ext. 400
Elma: (360)482-5269 Ext. 400 Receipt Number .57_a�/a2S
Fax (360)427-8442
Applicant Information -� Type of Review
Applicant TC>Wm Sw i/n 1 olpso , 1 5, Date I-/7// 0 Building Permit
Mailing Address PQ BD�< l lt, °1 0 New 0 Replacement
?2,,e Aoy W A 5 5 0 Commercial Building Permit
City // State Zip 0 New 0 Replace ent
Daytime Phone Other Phone '�D 275-67 0 Building/Commercial P;rmit Revision
O Tenant Review
E-Mail Address 1 @ �1c��-- �av� El Pre-Application
Parcel Information "l :—;?OA
12-Digit Parcel Number 123*zu 32--C)(010 1 z 320 -32 - 02000 A
Site Address I nV:U ,v- [- 320 734 0001 O -
Street Number Street Name Jr /Ps5'e city
Type of Job ( Please submit a scaled plot plan
Describe work � /7b_' Cl„rG� P L�f �� I/1V�� howing all existing an proposed
building, on-site sewage system,
Number of Bedrooms �) X 3 f and well.
On-Site Sewage Information Water System Informa on
jd On-Site Septic System 0 New 0 Existing Plumbing in structure? O Yes 0 No
0 Sewer Name of Sewer System If yes:
Using an existing on-site septic system will require a current Please submit a complleted 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 FWature
M Date
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
Revised 12/17/09
PAR a
DATE
PRE-APPLICATION CONFERENCE REQUEST FORM
The purpose of the pre-submission conference is to identify and/or eliminate as many potentii 1 problems as
possible in order for the project to be processed without delay. Representatives for the Fire Marshal's ice, Building
Department, Environmental Health, Planning, and Public Works Departments may attend the meeting to discuss rules
and regulations applicable to the proposed project. Topics covered during the meeting will include the omprehensive
plan, shoreline program, zoning, availability of sewer and potable water, development concepts, building construction,
fire protection and life safety concerns of the proposed project. The pre-submission conference will be most informative
when you provide accurate and detailed information on the Pre-Application Conference Application Form and the site
plan. Applications will be accepted when all information is received and deemed complete.
Pre-Application Conferences are held every Wednesday and last up to one hour. To sche ule a meeting
complete the applications and return with 10 copies of the detailed site plan,b 3:00 PM on the Wednes a two weeks
prior to the proposed meeting.
1.Pre-Application/Dept. of Community Dev. 2. Environmental Health
426 W Cedar Street 415 N 5th
Shelton,WA 98584 Shelton,WA 98584
360.427.9670 ext.352 360.427.9670 ext. 400
Check amount: $255.00 Check amount: $57.00
BOTH CHECKS MADE PAYABLE: MASON COUNTY TREASURER
Site PI
Applicant:
Name: �n Submit 10 opies
Mailing Address: 0 Xl 1 I al Include thefol[owi information
Daytime Telephoner 7 731—:7f01 Fax: (O
Z7 5'-' bd D �ff Indicate Scale and N rth Arrow
6 Property line dimensi�Ons,easements,
Email address: G � and right-of-ways.
Representative: —{ .o The location of all existing and
Name: Z I ef'J, l Ci7y` proposed structures.Include square
9(.t52`ts footage of existing d proposed
Mailing Address: ?0 1;D)k ( I t ROIL t`I"' structures.
Daytime Telephone:36 D -73 f=7l CJ 1 Fax 3 6D 64 00 � Setback distance,in eet from all
Email address: property lines and st ctures.
Parcel Number: (12 digits) d3 Existing and propos d road access to
and from the site.
Description of Project: t9 Parking sites
Include: 1) Square footage of structure, 2)Use of building and rooms(i.e.,
@ Location of on-site lewage tanks and
office,warehouse, restaurant,storage,etc), 3)Occupancy classification per drainfields.
IBC, Section 302.1,and construction type. 4)Provide two sets of plans, if a Location of drinkin water supply.
Include location on a proposed site
available. Use separate sheet if necessary and surrounding p els.
LA!'CfQ r Si/�eL i ✓ { ilSln f�
� el Steep bluffs,wetlands,streams,and
Lr n t 2 2(L ( 0 1 ti TD bodies of water
t
pt✓c e 1 S 2 $-1 A Er Location of fire by rants and
12 32(7— �2 — 010 10 emergency vehicle ccess roads,
�2320— 2� 02000 including grade.
I Z5'40_ 34. Q 00 I 27. Q R Surface and storm rater run-off mutes.
9Z. Z5 j-]c.re
Fps the project been discussed during a previous Pre-Application Conference: If yes,please indicate date.
Will the building have employees? If yes, how many? R
What is the water availability of the proposed project? If there is an existing well, what is the nama of the
system? h A iy' l/V e
What is planned for the on-site sewage system? If you are proposing a new on-site system provid�detail on the
required site plan.
I
ADDITIONAL INFORMATION:
G 'rt�)
APPLICABLE BUILDING CODES
2009 International Building Codet2009 International Residential Code
2009 International Fire Code-ANSI A117
2009 International Mechanical Code—WAC 5142
2009 Uniform Plumbing Code—WAC 51-56/51-47
2009 Washington State Energy Code—WAC 5 1-11
Mason County Ordinance
Date of Conference: Time of Conference:
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ext.
Location of Conference: 426 West Cedar Street,She/ton Planner:
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DISCLAIMER AND LIMITATION OF LIABILITY
The data used to make this map have been tested for accuracy,and every effort has been LEGEND I
made to ensure that these data are timely,accurate and reliable.However,Mason County
makes no guarantee or warranty to its accuracy as to labeling,dimensions,or placement or by these data are Roads rq faderat Tanis
location of any map features Contained herein.The boundaries depicted
- approximate,and are not necessarily accurate to surveying or engineering standards,and are Highways ON of Sheboo
intended for informational purposes only.Mason County does not assume any legal liability I
or responsibility arising from the use of this map in a manner not intended by Mason County. R,vars 3 Streams (� Cw++tY&sur{dary{GNR)
In no event shall Mason County be liable for direct,indirect,incidental,consequential,
special,or tort damages of any kind,including,but not limited to,loss of anticipated profits P3mels * Comm,ssren�r Crstnnts
or benefits arising from use of or reliance on the information contained herein
Sections Lakes
0 02009-Mason County GIS Tbwnsngs 7 Puget Soup g Melor Lakes
100 W.Public Works Dr
Shelton,WA 985M
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