HomeMy WebLinkAboutPAR2015-00010 - BLD CD Environmental Health Review - 3/3/2015 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health OffijoA use only
415 N. 6th Street Permit Number:
PO Box 1666
Shelton, WA 98584 Date Received: • ZD15
Shelton: (360)427-9670, Ext.400 Belfair: (360)275-4467 Ext. 400 Amount Received 2D4 0()
Elma: (360)482-5269 Ext. 400 Receipt Number I v�l1is — 1-1 Z
Fax (360)427-7787
Applicant Information Type of Review
Applicant Mo son6NI,4 ft're UJ sjy cr3 Date 3� O Building Permit
Mailing Address PO 4jax 129 E3 New O Replacement
C�Yg6eu10W l�jA 418Sy (o O Commercial Building Permit
City 3 6 o State 3G o Zip
O New O Replacement
0 Building/Commercial Permit Revision
Daytime Phone 215.qY83Other Phone 424- G Izl O Tenant Review
E-Mail Address Chirrc. \N &uecc.6 le- , C (.w pre-Application
Parcel Information
12-Digit Parcel Number 12/OS - Z I - C 00C 11
Site Address +350 (ter c,;o2vu e�� Loo12 ROCkJ i GI"awbeUtt{41�
Snell Number Sweet Name a.rry
Type of Job Please submit a scaled plot plan
Describe work Burl k roDvl t nlJ ;41 on �� showing all existing and proposed
�i building, on-site sewage system,
Number of Bedrooms 2 Ficeshaf)on. and well.
On-Site Sewage Information Water System Information
On-Site Septic System O New Existing Plumbing in structure? O Yes WNo
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.
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App ' nt i ture
C a. r o..l a acre. Date 3—3-/S
rr .0
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Official use only
Departmental Review Approved Denied Notes
Water Adequacy
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On-site Sewage System
Tenant Review
Revision
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