HomeMy WebLinkAboutBLD2021-01772 - BLD Application - 6/9/2022 °'PLAN MASON COUNTY COMMUNITY SERVICES Permit No:TMAEI dJ 11a
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0 PERMIT ASSISTANCE CENTER: I ; �� JJ'��
•., ••BUILDING ••PLANNING ••PUBLIC HEALTH••FIRE MARSHAL R E C ���/! I V E IJ
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� ` o i�Y 615 W.Alder Street,Shelton,WA 98584 juN � n �t,�,
7�. f~ 4/ . one Icon:(360)427-9670 ext. 352•Fax:(360)427-7798 wine L+
r., , air(360)275-4467•Phone Elma:(360�4$2-,5,Z¢9Aider Street DEC 0 Q0�J 0 9 2022
)0.HLnv ?' - 110 W.®"�. BUILDING PERMIT APPLICATIO11�15 V. Padi6rl'Stli r Street
PR ;• OWNER INFORMATION: CONTRACTOR I► ORMATION:
NA1E: 4nie( ; /Jctv)c. Ve,S4 NAME: IIri IDl'11j
MAILING ADDRESS: � 2/ , 6I-e^N Wd�/ MAILING ADDRESS:
CITY:Cjr evlei,J STATE: tJA ZIP: fS vs I CITY: STATE: ZIP:
PHONE#1:� ,Z53 3 ICE 75.E PHONE: CELL: I
PHONE#2: g 5 ? re''h ,c 5 V2 EMAIL :.
EMAIL:SEA M c/S'f- C ,Y5L , c e;''mil L&I REG # EXP. / /
PRIMARY CONTACT: OWNER i CONTRACTOR ElOTHER❑
NAME VQf i9f ,eis- EMAIL 72IAM t fisr 617 AZ ,iC,D/1'1 ) /
MAILING ADDRESS 3/ E" 6reew Gc)� CITYGr: ep/?(,✓ STATE 4.24 ZIP,....7
u`�7` •
PHONE 2' /CELL 55' VG4 57f
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 7 2-1/3 3 / 'O 0 -. 3 ZONING 2'5-
LEGAL DESCRIPTION(Abbreviated) / (Z.4 /V( ,5'LJ 7 s'P# 7Z 6 FIRE DISTRICT/t/4'J ot✓
SITE ADDRESS 1 l F. (. r'eAI wt ^CITY & ✓� _I✓i!_id
DIRECTIONS TO SITE ADDRESS U C7✓u t& 'o��' le: , `�,r-,;, , E.✓✓ri%Aim / c.1 7 till
1 e-P-� 0)110 6(r9p (Air, ! .
IS THE PROJECT WITHIN 300 FT OF S1LOPE(S)GREATER THAN I4%: YES❑ NO NI SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF'THE FOLLOWING: (Check all that apply):
SALTWATER ❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND:® SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW II' ADDITION ❑ ALTERATION 0 REPAIR❑ OTHER ❑
USE OF STRUCTURE (Residence,Garage,Commercial Bldg,Etc.) Key/deNCf
IS USE: PRIMARY WI SEASONAL ❑ NUMBER OF BEDROOMS_ p� NUMBER OF BATHROOMS v2
HEATED STRUCTURE? YES(Whole Bldg) E YES (Part[s]of Bldg) 0 NO 0
DESCRIBE WORK (oMQll IDi to vi4 i .61e6
SQUARE FOOTAGE: (proposed),
1ST FLOORJ4ou q. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq.ft. .
DECK geft. COVERED DECK , ft. STORAGE sq. ft. OTHER _sq.ft.
I
GARAGE sq.ft. Attached FADetached 0 CARPORT sq. ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE El,-------_____ YEAR L NOTHNR
W)D BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC Fjj, SEWER 0 / NEW it EXISTING ❑
PLUMBING IN STRUCTURE? YES al NO 0 Ifyes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NON EXISTING SQ. FT.
EXISTING BEDROOMS o� PROPOSED BEDROOMS 01. TOTAL BEDROOMS oil--
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocations Acknowledgement of such is by
signature below. I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed. I have
obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit'application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATI N O 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
'� COUNTY CODE 14.08.42)
Cfr�-(� , ,fie D / cZ/ .614
X 1 .
Signature of OWNER(Must be signed by the OWNER) / Date is_C+ Ail I—(Zed
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH \'' 1 1 (ZZ- C 1 1 �j 6J-ckJ
STADIUM BEACH ROAD WEST
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Arctos Aerial
PO Box 2466
Shelton, WA 98584
(360) 229-3118
arctosaerial@gmail.com
www.arctosaerial.com Environmental Consultation I Drone Imagery
June 6, 2022
Attention:
Rhonda Thompson—Mason County Public Health
This letter is regarding the septic design for Permit# BLD2021-01772. On June 27, 2022, I visited the site
to verify setback measurements from all streams and wetlands as requested by the septic designer
Micah Halverson. I previously delineated and rated the small slope wetland adjacent to the west Ns
stream and was able to find my original pink flagging. I measured exactly 100ft from the closest
drainfield stake to the closest edge of the wetland. On the other side of the septic design, I measured at
least 102ft from the closest drainfield stake to the closest point of the east Ns stream. Based on these
findings in the field, I conclude that the septic design, as laid out by the designer,conforms to the 100ft
minimum setback to all surface waters.
Please let me know if you have any questions.
Regards,
Rob Nagel
Co-owner/Biologist/Remote Pilot