HomeMy WebLinkAboutCOM2016-00067 - COM CD Environmental Health Review - 3/21/2016 RECEIVED
MASON COUNTY PUBLIC HEAL? '� OFFICIAL USE ONLY
IxlerecNve3
COMMUNITY DEVELOPFW. 1> der ZI—
ENVIRONMENTAL HEALTH REVIEW PC by:
415 N.6th Street Shelton,WA 98584 I� OU
case name .
(360)427-9670,Ext.400 (360)275-407,Ext.400 �19m 7 n t CO �9
1.Applicant/Property,Information -
ApplbsttName O t Assessors Pasch Number —
V
N1allir,Addns- ap
C
saeaeensa- s ay C� /
a (AO
Contact cnnraRPnme ,- C FmW
wta� . Go/�
2.Type of ew/Job 3.Job/Site Information
G alldvdapply
❑ Residential KCommercial ❑Tennant Review
❑ New ❑ Replacement ❑ Pre-Application + _
❑ Remodel ❑ Addition ❑Other(explain below) redm . eea,o I Twleeemom,
Des%,Ibe Work r UsermrmioMs,aedsiascorraPlacerenb
b
tti -45-4 I + �, = 5o85
Egs"5%R Proposed Sp Ft Total Sq.R
644 S/T- B emtyesorm) 170 Twlwrnb orF
ee I
I Wim Remodels ndto attach an edstinlg Floor Plan and Proposed Floor Piro
with mom designations.Mm Paper site 11x17. AopenyonS lna(wsorro) ��
4.On-Site Sewage System/Sewer Informadon
PedmetespraNSPmposednyesorno) 7
PmPatrservetl sy:
On-Site Septic System ❑ New XExisting "wwao/anplgela aapplohkJ 7
❑ Sewer ❑ New ❑ Existing S.Water Source Information
Permx No.W.PFilnble) Plumbing in structure? ❑ Ces ❑ No
Nameoi Se Syaten(rapplia ) If yes: no+ir\t Yl�(�hE,w
Using an existing o"Ite,septic system Will require a current mainterence report Please submit a completed er Adequacy Form.
and a Record Drawing(Asbuin).Documems for both of these requirements may An Incomplete submitted Water Adequacy Form may be
be on file with Mason County Public Health.Other requirements may apply. returned,and hold up review process.
Site Plan
A scaled Site Plan is required with all permits,except Interior remodels.An incomplete submitted site plan may be returned,and
holdup review process. Paper size for site plan can be B.Sx11,8.5x14,or t tx17(max). Please use checldist below:
❑Property lines/dimensions ❑Pdmary Drainfield area ❑Reserve Drainfield area ❑Existing/proposed wells ❑Waterlines
❑SepticTanks location ❑Location of curtain/perimeter drains ❑Direction of Slope ❑Ddveways/Parking areas/Easements
❑Existing Structures/buildings ❑Proposed Structures/Buildings ❑Sewerlines/tanks ❑Additions ❑North Arrow ❑Scale Bar
Applicant Signat< Date
Official use only
Departmental Review Approval Intls. Date Notes,Conditions,Related Permits
Water Adequacy
Sewer/Septic System 2s p Q
Tenant Review
Revision
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLICVIEW ON THE MASON COUNTY WEBSITE Revised 2/6/2015
EXISTING ASPHALT - EXISTING GRAVEL
o
Z
0
U
z ARC
0
U
l o PLLC
LL
Q
F-
601 St. He
r r
z Tacoma,)
LD Phone: (2
w
Project nue,
a
o VOLM
3 0 FIREFI
z w ADDITI
W FIRE H
0 4350 GR
ROAD
GRAPES
w
W sheet Title
m
k MITION SITE
J'
W
L w
- EXIS z
z
r,,:. w
d ci co 7
Ali$-Om �tk-
Tic FRS ��scml A14 ,� Slime p��
GL NAP;J, e r� fa t c
� � 1J t4-.i , 11 NZ�
eK b�� �� `�c �c�►ivJ 'c e 12� ��i�
I e-