HomeMy WebLinkAboutPAR2012-00005 - BLD CD Environmental Health Review - 3/13/2012 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
Belfair: (360)275- 467 Ext.400
Elms: (360)482-5269 Ext.400 Receipt Number
Fax (360)427-7787
Applicant Information Type of Review
Applicant Kenneth A. Krohn Date 3/8/12 0 Building Permit
Mailing Address 550 NE Lakeridge Dr. 0 New 0 Replacement
Belfair WA 98528 0 Commercial Building Permit
City State Zip 0 New 0 Replacement
206-598-6245 a Building/Commercial Permit Revision
Daytime Phone Other Phone 206-790-4333
O Tenant Review
E-Mail Address kkrohn(o)uw.edu I,a Pre-Application
Parcel Information
12-Digit Parcel Number 223 047 690010
Site Address 550 NE Lakeridge Drive, Belfair 98528
Street Number Street Name City
Type of Job Please submit a scaled plot plan
Describe work Convert garage to winery showing all existing and proposed
Number of Bedrooms N/A building, on-site sewage system,
and well.
On-Site Sewage Information Water System Information
® On-Site Septic System 0 New W Existing Plumbing in structure? 19 Yes 0 No
0 Sewer Name of Sewer System If yes: Erickson Lake Homeowners Assoc.
Using an existing on-site septic system will require a current Please submit a completed Water
maintenance eport and a Record Drawing (Asbuilt). Documents Adequacy Form.
for both oft se requirements may be on file with Mason
Cou P lic Health. Other requireme is may apply.
Aft t Signmo -'7
Date 01O'`
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
Revised 12/17/09