HomeMy WebLinkAboutBLD2011-00570 - BLD CD Environmental Health Review - 7/11/2011 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH R VIEW
Mason County Public Health Official use only
415 N. 6th Street Permit Number: I-bcglr
PO Box 1666
Shelton, WA 98584 Date Received: 1 1-261
Shelton: (360)427-9670, Ext. 400 Amount Received ;Lou . 00
Belfair: (360)275-4467 Ext.400
Elma: (360)482-5269 Ext.400 Receipt Number
Fax (360)427-7787
Applicant Information Type of Review
Applicant IoT,6 A -�es2 CA Dated-��'/� Building Permit
Mailing Address Nao Zv r)ef-v+II r Dr A/C New 0 Replacement
ij G k r W n 985 Z?s 0 Commercial Building Per it
City State Zip 0 New 0 Replacement
Daytime Phonq'7;2-244-7 Other Phone 9cio-D7S o O Building/Commercial Permit Revision
^ 0 Tenant Review
E-Mail AddressL esck9_ o-1Yo.knc> CcLm 0 Pre-Application
Parcel Information
12-Digit Parcel Number - S - 00330
Site Address Zpyp nE e..
Street Number Street Name City
Type of Job 1 Please submit a scaled pi A plan
Describe work_�)vrI[l .3 h.cdr�M L�or-,k_ showing all existing and I iroposed
building, on-site sewage system,
Number of Bedrooms 3 and well.
On-Site Sewage Information Water System Informatio
On-Site Septic System �M New 0 Existing Plumbing in structure?'�-81 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.
Applic rt Sign �
Df Date-7- 1 I- ?oil
7'
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
Revised 12/ 7109
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