HomeMy WebLinkAboutCOM2014-00858 - BLD CD Environmental Health Review ENVIRONMENTAL HEALTH REVIEW FOR COMMUNITY DEVELOPMENT
Mason County Public Health Official use only
415 N. 6th Street Permit Number: r�'m/�✓��—LSLRJ
PO Box 1666
Shelton,WA 98584 Date Received:
Shelton: (360)427-9670, Ext.400
Belfair: (360) 275-4467 Ext. 400 Amount Received o . w o
Elma: (360)482-5269 Ext. 400 Receipt Number
Fax (360)427-7787
Applicant Information Type of Review
Applicantn,a AP,-9-D -IFno" Date. Id Building Permit (commercial or residential)
Mailing Address V 0 New XReplacement
15. I \//AI�X o � �g 0 Remodel 0 Revision
City State Zip 0 Tenant Review
Daytime Phone Other Phone 0 Pre-Application
E-Mail Address
Parcel Information
12-Digit Parcel Number 1 z 3 2-9 -O a� -6
Site Address
Street Number Street Name City
Type of Job Please submit a scaled plot plan
,�1
Describe work t _w) d-C.:AjoVL, Q24VL r'_ showing all existing and proposed
Existing Bedrooms Proposed Bedrooms building, on-site sewage system,
and well. Max Size 11 x17 .
On-Site Sewage Information Water System Information
d On-Site Septic System 0 New 0 Existing Plumbing in structure? Yes 0 No
Sewer Name of Sewer Systert6E29� 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
for both of these requirements may be on file with Mason Adequacy Form.
County Public Health. Other requirements may apply.
Applicant Si natured I
2nA G Date L/ �D
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE
Official use only
Departmental Review Approypd Date Notes, Conditions, Related Permit Vs
Water Adequacy
On-site Sewage System
Tenant Review I L1 r76 D
Revision
i
Revised 1/10/2014 ?,
i
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
July 17, 2014 PO BOX 1666 Shelton WA 98584
Shelton (360)427-9670
Fax (360)427-8442
ORCHARD LLC Elma (360)482-5269
9550 NW NEWBERRY HILL RD
SILVERDALE WA 98382 Belfair (360) 275-4467
Case No.: COM2014-00085 Parcel No.:123294100081
Dear Applicant:
Your building permit will not be approved by Mason County Public Health until the following
items are completed and received in our office.
Application for water adequacy completed and signed by the water system manager.
Please see comments at the end of this letter.
Please call me at (360)427-9670, ext. 279 if you have any questions.
ASinc rel
lex Paysse
Environmental Health
Mason County Health Services
Comments: Water adequacy form was submitted unsigned. Need a signed water
adequacy form from the Belfair Water District. Also, sewer utility connection
fees must be paid prior to issuing permit. You may contact utilities at
360-427-9670 ext. 207.
7/17/2014 Page 1 of 1 COM2014-00085
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