HomeMy WebLinkAboutBLD2011-00224 - BLD CD Environmental Health Review - 3/25/2011 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Off ic{ii1 l use only
415 N. 6th Street
PO Box 1666 Permit Number:
Shelton, WA 98584 Date Received: .
Shelton: (360) 427-9670, Ext. 400
Belfair: (360) 275-4467 Ext. 400 Amount Received
Elma: (360) 482-5269 Ext. 400 Receipt Number
Fax (360) 427-7787
Applicant Information Type of Review
Applicant zzk 1�c6� Date3 S /� 0 Building Permit i
Mailing Address 4 �{2 o New O Replacement
0 Commercial Building Permit
City State Zip 0 New 0 Replacement
Daytime Phone Other Phone 360 E3 Building/Commercial Permit Revision
E-Mail Address 0 Tenant Review
O Pre-Application
Parcel Information
12-Digit Parcel Number 32 s3d 5 !U boo
Site Address 19S i(/ CFfn/srG H/00 .4 6v4� �/o�/r�az
Street Number Street Name City
Type of Job Please submit a scaled plot plan
Describe work 41z-ztl 5�,� ,� showing all existing and proposed
Number of Bedrooms building, on-site sewage system,
and well.
On-Site Sewage Information Water System Information
n-Site Septic System 61 ew E3 Existing Plumbing in structure? ,des 0 No
O Sewer Name of Sewer System
�'y/"'�
If yes: " -.ems /�rn171 /,�0
Using an existing on-site septic system will require a current
maintenance report and a Record Drawing (Asbuilt). Documents Please submit a completed Water
for both of these requirements may be on file with Mason Adequacy Form.
County Public Health. Other requirements may apply.
Ap Si at
Date
Official use only
Departmental Review A ro d Denied Notes
Water Adequacy
On-site Sewage System J
Tenant Review
Revision
Revised 12/17/09
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