HomeMy WebLinkAboutBLD2011-00547 - BLD CD Environmental Health Review - 7/5/2011 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: I
Shelton: (360)427-9670, Ext. 400
Belfair: (360)275-4467 Ext. 400 Amount ReceivedJ( P
Elma: (360)482-5269 Ext. 400 Receipt Number
Fax (360)427-8442
Applicant Information Type of Review
Applicant Date !I I 0 Building Permit
1 0 New O Replac ent
Mailing A ress 2 c" T
1tl�6 is� )ea 0 Commercial Building Permit
City State Zip 0 New 0 Replacement
Daytime Phone 6DI2- Other Phone O Building/Commercial Permit Revision
0 Tenant Review
E-Mail Address 0 Pre-Application
Parcel Information
12-Digit Parcel Number ZZ3v� 60 Z
Site Address I_Z L4 I AL L., W4 ` kLL
Street Number Street Na a City
Type of Job Please submit a scale plot plan
Describe work CQ VY) tY'uc`t' hey 1jj Cam_ showing all existing a d proposed
Number of Bedrooms 2_ building, on-site sewa a system,
and well.
On-Site Sewage Information Water System Informa ion//
On-Site Septic System 0 New 0 Existing Plumbing in structure? 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 complIeted 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 n re
Date /
Official use only
Departmental Review Approved I Denied Notes
Water Adequacy 72i �l
On-site Sewage System I(
Tenant Review
Revision
Revised 12/17/09
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