HomeMy WebLinkAboutBLD2012-00065 - BLD CD Environmental Health Review - 2/6/2012 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Official use only
415 N. 6th Street Permit Number: CC
C cT
PO Box 1666
Shelton,WA 98584 Date Received:
Shelton: (360) 427-9670, Ext. 400 Amount Received
Belfair: (360) 275-4467 Ext. 400
Elma: (360) 482-5269 Ext. 400 Receipt Number
Fax (360) 427-7787
Applicant Information Type of Review
Applicant 6,814 Date 17, Building Permit
Rd
Mailing Address New o Replacement
�
y g5 f O Commercial Building Permit
O New E3 Replacement
City State Zip
17 Building/Commercial Permit Revision
Daytime Phon o 61 ZOZLOther Phone 61oo)yg3-oNV1 O Tenant Review
E-Mail Address d bocksctl @ cmricast,nef O Pre-Application
Parcel Information
12-Digit Parcel Number 7210-7 — �b— 000Ll(a
Site Address 179D F Masan Lake Or S re✓'ea
Street Number Street Name City
Type of Job Please submit a scaled plot plan
showing all existing and proposed
Describe work Rice sfinti Q< 1 ar,uS building, on-site sewage system,
Number of Bedrooms -e- and well.
On-Site Sewage Information Water System Information
)4 On-Site Septic System New 0 Existing Plumbing in structure? XYes I7 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.
Applicant
Date gllahz
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sewage System (Z Z
Tenant Review
Revision
Revised 12/17/09