HomeMy WebLinkAboutBLD2018-00370 - EH General - 4/18/2018 ENVIRC; ENTALRECEIV
MASON COUNTIJ ALTH OFFICIAL USE oNLv
COMMUNITY DEV �ENT '��' 18 2 received:
ENVIRONMENTAL HEALTH REVI9W Amount received Received by:
Alder treat
415 N.6th Street, Shelton,WA 98584
C number:
(360)427-9670,Ext.400 (360)275-4467,Ext.400 `ram
1.Applicant/Property Information 11 `Y��—
Applicant Name C, � "" .��`i�,,{y - � Assessors Parcel Number 12,
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.Mailing Address- Street City State Zip l2' t� 55 ,1f,�� ««^9ggr •4J`w"1t tt
Site Address- Street City j ,p g y�, aQ
Ro 13 ' a 9 t tf: '� t. ! 9 .:, iu£nd Y 1 U.) v v
Contact Person �° Contact Phone Contact Email y�-� �,ry qq
t@ " roi ;,> tsL ■/Y.9+c/ 3 "t#7fk�'� ` Vill
2.Type of Review/Job 3.Job/Site Information
Check all that apply
❑ Residential ❑ Commercial ❑Tennant Review❑ New Replacement ❑ Pre-Application ED + 0 _
Existing Number Proposed Additional Total Bedrooms
❑ Remodel ❑ Addition ❑ Other(explain below) Bedrooms Bedrooms
Descn be Work Use for remodels,additions, replacements
Existing Sq.Ft Proposed Sq.Ft. Total Sq.Ft.
_ Basement?(yes or no) Total Number of Floors
Interior Remodels need to attach an Existing Floor Plan and Proposed Floor Plan N)0
with room designations. Max Paper size 1 1x17. Property on Shoreline(yes or no)
4.On-Site Sewage System/Sewer Information 1\4 Q
Property Served By Perimeter Drains Proposed?(yes or no)
:
On-Site Septic System New Existing
Number of Employees(if applicable)
❑
❑ Sewer Connection El New Existing New /J ty
5.Water Source Information
Permit No-of applicable) --- Plumbing in structure? Yes ❑ No
Name of Sewer System(if applicable) If yes:
Using an existing on-site septic system will require a current maintenance report Please submit a completed Water Adequacy Form.
and a Record Drawing(Asbuilt). Documents 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.
6.Site Plan
A scaled Site Plan is required with all permits,except interior remodels. An incomplete submitted site plan may be returned,and
hold up review process. Paper size for site plan can be 8.5x11,8.5x14,or 11x17(max). Please use checklist below:
Property lines/dimensions ®Primary Drainfield area M Reserve Drainfield area OExisting/proposed wells O Waterlines
Septic Tanks location ❑Location of curtain/perimeter drains ❑Direction of Slope
p ❑Driveways/Parking areas/Easements
,Existing Structures/buildings ZProposed Structures/Buildings ❑Sewer lines/tanks ❑Additions IM North Arrow ®Scale Bar
Applicant Signature Date
1(iIUAL USE a}Ni_y
Departmental Review Approval Intls. � Date Notes,Conditions,Related Permits
Water Adequacy
Sewer/Septic System
Tenant Review
Revision
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE Revised 12/7/201S
ENVIRONMENTAL (.O I E)- 003-7 0
WEALTH
7- tc�
RECEIVED 5
APR 18 2018
615 W. Nder Street
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TOPOGRAPHY PROFILE:
i
Direction: Scale: Approval: for office use
r Building Permit number: 1 ,, 50 Building:
Planning:
Owner/Applicant: Gt2�16 u �+ t.: � ' Date of
application: Env. Health:
Parcel Number:�'�,.� �e'�,• �€�R����a
ENV1F Oi"41'MENTAL 003-0
HEALTH
RECEIVED He 6 � ; R 4" 4g
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APR 18 2018 M-4,t_- c 5a
615 W. Alder Street
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TOPOGRAPHY PROFILE:
Direction: Scale: Approval: for office use
Building Permit number: , 50 Building:
Planning:I.Owner/Applicant:_G� 1�1 jl� V6-UV5��V-f I" Date of
Percel Number: 7—16
application: Env. Health:
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