HomeMy WebLinkAboutPAR2011-00025 - BLD CD Environmental Health Review - 11/21/2011 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Official use only
415 N.6th Street Permit Number. -
PO Box 1666
Shelton,WA 98584 Date Received:
Shelton: (360)427-9670, Ext.400 Amount Received oU
Belfair.(360)275-4467 Ext 400
Elma: (360)4825269 Ext 400 Receipt Number
Fax (360)427-7787
Applicant Information Type of Review
Applicant Olympic Holdings LLC Date11 /15/1 ' 0 Building Permit
Mailing Address P.O. Box,,997 0 New 0 Replacement
Gig Harbor WA 98335 10 Commercial Building Permit
City State Zip 0 New I* Replacement
0 Building/Commercial Permit Revision
Daytime Phone 24;-405-44140ther Phone 0 Tenant Review
E-Mail Address 'bri atdrpanierach i cars cam 0 Pre-Application
Parcel Information
12-Digit Parcel Number 1 2329-4 2-001 90
Site Address
Street Number Street Name City
Type of Job Please submit a scaled lot plan
Describe work Commercial Site Redevelopment showing all existing and proposed
Number of Bedrooms N/A building, on-site sewagi i system,
and well.
On-Site Sewage Information Water System Informati n
On-Site Septic System 0 New 0 Existing Plumbing in structure? Yes 0 No
M Sewer Name of Sewer System W/t!Le in If yes: Belfair Wate
Using an existing on-site septic system will require a current Please submit a completed Water
maintenance report and a Record Drawing (Asbuift). Documents Adequacy Form.
for both of these requirements may be on file with Mason
County Public Health. Other requirements may apply.
Applicant Signs
Date lij,'1 L�f
Official use only
De artmental Review Approved 1139nied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
Rewsed 12117109