HomeMy WebLinkAboutwater adequacy - BLD CD Environmental Health Review - 5/25/2011 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health official use only
415 N.6th Street Permit Number: 130201 I-W4;-{
PO Box 1666
Shelton,WA 98684 Date Received: 25-201 1
Shelton: (360)427-%70,Ext 400 Amount Received 1�O
Beftr. (380)275-4467 Ext.400
Elmo: (360)482-5269 Ext.400 Receipt Number s Co
Fax (360)427-7787
Appilcant IM+ormatlon Cis a Type of Review
Applicant Date S io it Building Permit
Mailing Address ZZ 7 fie/ k*., n/r /B Now G Reptecernent
,Oc«yae� wA- 91 ::6 O CQ alNow DBuildi tit
City State Zip
Daytime Plane;W70699&her Phone 00791630yo 13 Building/Commercial Permit Revision
G Tenant Review
E-Mail Address, tom* j"y66E! atlbti9 •co►r+ p Pre-Application
Par Irdwaa don
12-Digit Parcel Number
Site Address 1417762 Aq. SA �r
Street Number ionName City
Type of Job _- / Plans submit a scaNd plot plan
Describe work &7kh-" 0 aN and i��d
Number of Bedrooms a+i1dMY.on-oft sewps sysbm+
On-Of sewage k wmadon Water,system ineonme"
On-Site Septic System 0 New KE-Assting Plumbing in structure? XYes O No
0 Sewer Name of Sewer System ff yen:
Using an existing on-site septic system will require a current Pismo submit a completed Water
mainlenence report and a Reowd Drawing(Asbuilt).Documents
for both of these requmanarts may be on Ab with Mason Adequacy Form.
County Public Health. Other requirements may apply.
Date
Official use only
1 Review Approved Denied Notes
Water Adequacy
On-s"sewage System /y
Tenant Review
Revision
r ; wr
g
t !
• •'ak...V"::5,• Ifi , "..�.1 ':' t:.4t�6. i' •..i:..'t �.._, :.. t. rY v
tr. L 1�I ram'
P
. +Mr
s
4N " NFWi' I ■■!
n
J
L�
Ie r
L