HomeMy WebLinkAboutApplication for Extension SWG2019-00436 - SWG Application - 11/5/2019 MASON COUNT 415 N 6TH STREET, SH 98584
SHELTON:360<27-9677-9670. E E XT.400
COMMUNITY SERVICES BELFAIR:360-275-4467,EXT.400
ELMA: 360-482-5269, EXT.400
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APPLICATION FOR EXTENSION
Amount Paid: $150 (check#2037 enclosed)
Receipt Numbe (M:
Instructions: Complete Parts 1 and 2. Submit application with extension permit fee. Make check payable to
Mason County Treasurer. Staff will review your application and determine if the extension can be approved. If
approved, the permit may be extended for up to one additional year from the original expiration date.
Extensions must be applied for prior to original expiration date. Multiple extensions on a single permit
Will not be approved (one per designipermit).
PART 1: APPLICANT AND PARCEL INFORMATION
Name of Applicant: Nathan Oakes Phone: (626)372-5851
Mailing Address of Applicant: 771 NE Southridge Drive
City: Beltair State: WA Zip: 98528
12-digit Tax Parcel Number: 32226-76-00100
Site Address: 771 NE Southddge Drive, Belfair, WA 98528
Permit Number: SWG 2019-00436
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION.
I planned to complete it by now,but the pandemic and recession put a strain on finances. I will be able to make it
happen in 2023. Thank you!
PART 3: HEALTH DEPARTMENT DETERMINATION (staffuse only)
❑ Extension Denied
Extension Approved New Expiration Date:
omments:
Environmental Health Specialist Signature:
This form may be scanned and available for u i on the Mason County Web site.
Revised: 12/132019
415 N 61H STREET,SHELTON,WA 9B5M
60 MASON COUNTY SHELTON:360427-9670.EXT 400
COMMUNITY SERVICES BELFAIR:360-275J 67,EXT 400
ELM:360482-5269,EXT 400
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On-Site Sewage System Permit: SWG2019-00436
APPLICANT NATHAN H OAKES ET AL Phone: 626.372.6851
Address: PAMELAJ FRANK BELFAIR,WA 98528
OWNER NATHAN H OAKES ET AL Phone: 626.372.5851
Address: PAMELA J FRANK BELFAIR,WA 98528
SEPTIC DESIGNER PAULA JOHNSON -Arrow Septic Phone: 360-898-2255
Designs
Address: 171 E VUECREST DRIVE UNION,WA 98592
Site Address: 771 NE Southridge Or
Primary Parcel Number: 322267600100
Permit Description: New three bed-pressure
Permit Submitted Date: 1110 512 01 9
Permit Issued Date: 12105/2019
Issued By: Luke Cencula
Current Permit Fees Paid: $605.00 laddnlorvrvi roas—yba rc9Wretl oFon�n:alianon o1 syste,xl.
Permit Expiration Date: 12/0412023 Ibd cndau,dIasrdmnl
Permit Conditions:
1 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
2 Dreinfield installation not to exceed designed upslope and do
wnslope depth specified on
design form.
3 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
4 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
5 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS,
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: www.co.mason.wa.uslhealthlenvironmentagonsiteloss-Inspection4equest.php or call:
360-427-9670,extension 400.