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HomeMy WebLinkAboutBLD2011-00470 - BLD CD Environmental Health Review - 6/10/2011 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW Mason County Public Health Official use only 'L 415 N. 6th Street Permit Number: 430261) - DOT7l) PO Box 1666 Shelton,WA 98584 Date Received: Shelton: (360)427-9670, Ext.400 Amount Received Belfair: (360)275-4467 Ext. 400 Elma: (360)482-5269 Ext.400 Receipt Number Fax (360)427-7787 Applicant Information Type of Review Applicant SfeU� GUa J elI Dater `/D-// D Building Permit Mailing Address 6K 7/ Alk Y ttk.s e r J. D New D Replacement Q N I{'i h (nJq . y D Commercial Building Permit City State Zip D New D Replacement Daytime Phone a7 3 Other Phone D Building/Commercial Permit Revision D Tenant Review E-Mail Address Ge�,ZeP. 5teye4P i/e g • c&-im D Pre-Application Parcel Information 12-Digit Parcel Number 2-),3 50 0 Site Address I '),V/ nir ri1%ss+'on irk vJ . Street Number Street Name City Type of Job Please submit a scaled plot plan Describe work Rap(a c c b't R,' a-m showing all existing and proposed building, on-site sewage system, Number of Bedrooms I and well. On-Site Sewage Information / Water System Information Or'On-Site Septic System 13 New © -Existing Plumbing in structure? *'es O No D 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 for both of these requirements may be on file with Mason Adequacy Form. County Public Health. Other requirements may apply. Applic�t S.,ri'gnat ire / Date !D l Official use only Departmental Review Approved Denied Notes Water Adequacy On-site Sewage System C 23 f Tenant Review Revision Revised 12/17/09 ~ � RECEIVED - c��L ---_- -- --- — - JUN 10 2011 426 W. CEDAR ST BUILDING �- 0 lA ., ; We \ - --