HomeMy WebLinkAboutBLD2011-00595 - BLD CD Environmental Health Review - 7/18/2011 Q;c��- �� '
` 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 1
Belfair: (360)275-4467 Ext.400 p�
Elma: (360)482-5269 Ext. 400 Receipt Number GL
Fax (360)427-7787
Applicant Information c Type of Review
Applicant / Date7�a /// 0Building Permit
0 New O Replacement
Mailing dr s
O Commercial Building Permit
O New 0 Replaceme t
City State ZIP
//��' ❑ Building/Commercial Permit Revision
Daytime Phone `�her Phone p Tenant Review
E-Mail Address E3 Pre-Application
Parcel Information O o
12-Digit Parcel Number
Site Address !tt_
City
Street umber treat ame y
Type of Job f
// Please submit a scaled p of plan
c e6 showing all existing and proposed
Describe work /� wilding, on-site sewage system,
Number of Bedroo _ and well.
On-Site Sewage Information Water System Information
On-Site Septic System O New jotxisting Plumbing in structure? es O No
O 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 re qui ments may apply.
Applic gnatur
Date
Official use only
De artmental Review Aipproved Denied Notes
Water Adequacy lR C
On-site Sewage System I II
Tenant Review
Revision
Revised 2/17/09
ENVIRONMENTAL
I HEALTH l k.Rci t cl + 3 t�
w
AZ-
�o
n 1
� 3
�Wy �
0
0
IS-V 13'-6'
cm
_ g o
N
N 4 �
10 O e
N
PA SkR P
cl
i1NM5/8RL .09 ` 1
k' R• SNEEVES
N 1�
N 4 N
V11U0 P Ol
S &R O
® R.A.G.30i
® N
6 N Ve0`
11aa Q
RRM1T LOyyC 9
�U Pk O O
A i
i N ® N
r R.
4 LMFiS/Bfll .09 i A
(2)24-SLIDER DOORS 30 1-
s ELr RAG ABOVE
4
DECO
S k R i m STO
cn H 0 k
® i p N
V
MZQY 5pn��
ezfiss �
_ Q
U NZ
U�
NA
08
O
AZ
42 �
UC! N
o
0
A
P
in
N