HomeMy WebLinkAboutBLD2011-00096 - BLD Application - 2/7/2011 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH IEVIEW
Mason County Public Health Official use my
415 N. 6th Street Permit Number: lid of l '
PO Box 1666
Shelton, WA 98584 Date Received:
Shelton: (360) 427-9670, Ext. 400 Amount Received o�
Belfair: (360) 275-4467 Ext. 400
Elma: (360) 482-5269 Ext. 400 Receipt Number 0 77
Fax (360) 427-7787
Applicant Information Type of Review
ApplicantQmoy 1 �Q Yf�ot -( ahS� 12�G�I` ate a-7-t/ )f Building Permit
Mailing Address D box 9 / / 8 0 New Replacement
La /"j'i G/ kr,-Ce�7 O Commercial Building Permit
City State Zip 0 New 0 Replacement
0 Building/Commercial Permit Revision
Daytime Phone S -r{ll Other Phone 0 Tenant Review
E-Mail Address�SQ rl e r5 • / c ✓y� 0 Pre-Application
Parcel Information
12-Digit Parcel Number O DO
Site Address O
Street Number Street Name City
Type of Job Please submit a scaled plot plan
Describe work Q'ALx11 &Uj-Ci'L showing all existing and proposed
building, on-site sewage system,
Number of Bedrooms and well.
On-Site Sewage Information Water System Information
0 On-Site Septic System A/iqew 0 Existing Plumbing in structure? 0 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 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.
Applicant Sig t e �_ �
Date
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sewage System IN t
Tenant Review
Revision
R id 12/17/09
Feb. 24. 2011 , 2:07PM 'Clayton Homes of Lacey No. 2447 P. 2
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MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
February 17, 2011 PO BOX 1666 She*WA
Shelton (3 0)427-9670
Fax (3 0)427-8442
STEVE DAMERON Elma (3 0)482-5269
100 NE CREEK VIEW PLACE
TAHUYA WA 98588 Belfair (3 0)275-4467
Case No.: BLD2011-00096 Parcel No.:223315000063
Dear Applicant:
Your building permit will not be approved by Mason County Public Health until the following
items are completed and received in our office.
Application for water adequacy completed and signed by the water system ma lager.
Accurate and scaled site plan. Including all buildings (actual and proposed), dr veways,
location of septic system, reserve area for septic system and all wells.
Please call me at (360)427-9670, ext. 279 if you have any questions.
Sincerely,
Amanda Reynolds
Environmental Health
Mason County Health Services
Comments:
2/17/2011 1 of 1 BLD2011-0 096