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HomeMy WebLinkAboutBLD2020-00488 - BLD Application - 1/20/2022 nevi SO Couh, Public .47 Health JAN 2 0 2022 Always working for a safer t; healthier Mason County 416 N.6th Street,Bldg 8,Shelton WA 98584 Michele Remmen x 566 UTW 360-427-9870 or 380-275-4487,extension 400 Application for Determination of Sewer Adequacy Instructions: 1:Complete;Part 1 of application. Permit number maybe added at later dater �'i' +- 2,'lake:appl(cation,Site plan,.and any'other associated Information_khith,the proposed:development to the Sewer ,:,System:Manager or Designated Employee for approval.; 3.Submit completed application and Informationto Permit Center o'r Mason'County Public Health for review. NOTE:You must supply the•System Manager with a site plan for.,theproject,,sho ing all existing or proposed• sewer..components and;lines in relation to.proposed development'and property.`., +, - Part 1:Applicant I Parcel Information Applicant: J &J Development, LLC Date: 1/18/2022 Mailing Address: PO Box 137 City,state,Zip:Fox Island WA 98333 Site Address: 101 E Sullivan St Phone: 253-208-8136 Parcel Number: 12220-50-60008 Permit Number: ICJ I4 21D1D ' 660455 Block 60 Lot 8 Part 2: Sewer System Information Name of Sewer System: 1\10(4, (3 y/(A58.. nler ® Site Plan attached? Official use only: Sewer System Manager or Designated Employee Is to complete. tij New Connection: I have reviewed the applicants information and have no Issues with Mason County Public Health approving the corresponding Mason County Permit. ❑ Existing Connection: I have reviewed the applicants information and have no Issues with Mason County Public Health approving the corresponding Mason County Permit. ❑ 1 have reviewed the applicants information and have determined sewer connection is currently NOT available to this property. (} Please add the following condition(s)on the corresponding Mason County Permit:(optional) 5tui CC',2f\s ci o \ IrmnA' t' -sow COkAy� he511n GntJ C,r.s6c. o0 S4z1/4.40.r s c)( WOAR-WCATA. Ohl;\-e5 r C o nr\cc: oc\ cee�.5 NIA), D toe sxj, ` �hr Platt 5 ,t.> 2b8/2.az.2 Printed Name of System Manager!Employee ignelure of System Manager/Employee Date Part 3: Mason County Public Health Review/Approval "11 ' ` `" ` 1 I,��) Satisfactory El Unsatisfactory 11 b r Signature of Environm Mal Health Specialist gate -Atf d'd This form may be scanned and available for public view on the Mason County Web Slte. REVISED 10/28/2015 -2:>1 cl ZoZo - oo4 88 NORTH BAY SEWER PORT OF ALLYN WATER ALLYN UGA R.2 TABLE WATER LEGEND SANITARY SEWER LEGEND 12_11 WATER METER BOX •®SEWER MAIN CONNECTION \t, w WATER HOOKUP ®CLEANOUT `— M WATER MAIN CONNECTION ®LOT STUBOUT 1 A\ _� 0 4' VALVE ®SANITARY SEWER MANHOLE X CROSSOVER X CROSSOVER Q g // PPn, / 3 / 30 ^„' !J o/ oc ; 3 / JU' / 1ASON COUNTY • / EhpVI,aUNMEtiTA1 HEALTH 60 / ~�© cot 9 3 © S 7`;00 00..E ?0 /e 120 00 l GqR �' /IQ ?1 loo SO • / 0 i O ', r 12j2 SQ F /,o ll `' "°USE T,/Ao . � COr8 4 3ro =/ e o s ?3bo oo. , & �, / E ?0 ? / cot o0 3 s r� o° AO 30 co 2 B<K 59 20 FRONT PORCH 132 SQ. FT. REAR PORCH 88 SQ. FT. {,EGAL DESCRIPTION ADDRESS LOT 8 BLOCK 60, 101 E SULLIVAN STREET BATJACK HOLDINGS LLC PLAT OF ALLYN, ALLYN, WA. 98524 P.O. BOX 2269 VOLUME 1 OF PLATS, PAGE 17 GIG HARBOR, WA 98335 AP No. 12220-50-60008 CEO 1857 (253) 208-8136 GP % SITE PLAN MAP AGATE LAND SURVEYING, PLLC G.B>;c� of xA*. ° FOR 2680 AGATE RDPROFESSIONAL . BOX 246 q SURVEYOR ii titib00 BATJACK HOLDINGS LLC TON, WA 98584 - (36O) 426-4172 -o o IN THE DRAWN BY DATE: 01 10 2022 JOB Na 0� 28237 W NV/4 NE1/4 MOB 4148-6008 ASS �ISTER�1i� 4 SCALE 1 INCH = 30' SHEET: 1 OF 1 I°hAL inK�s LDZ"'� SEC 20, T22N, ROl W, W.14. CHECKED BY SGB ALE NO: 4148-6008_CH_SITEPLAN.DWG