HomeMy WebLinkAboutBLD2023-00010 - BLD CD Environmental Health Review - 1/5/2023 ..,
0v`S'_:C•PL.i,,,,tr MASON COUNTY COMMUNITY SERVICES P¢I 6Ptiwa�'('CO'(J
PERMIT ASSISTANCE CENTER: II\'tI•�—`'-JJ
I' rell •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
-I I• 5 615 W.Alder Street,Shelton,WA 96584 n n
Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone 0 JAN
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.i` Phone `rBelfair.(360)275-4467•Phone Elmer(360)482-5269
BUILDING PERMIT APPLICATIt 5 W. Alder Street
Fri
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: Z
C NAME: L41 CI A R.lag, NAME: `..iiim
MAILING ADDRESS:CI I W, KALI alit aQ MAILING ADDRESS: = M.
CITY:S NEL TON) STATE:W A ZIP:°6 84 CITY: STATE: ZIP:
PHONE#1: 56p0• 6S(p• 1000 PHONE: CELL: D
PHONE#2: EMAIL:
EMAIL:SUNN)IN SEA ITL2 y.14i4O0-0.-Cisel L&I REG# EXP._/_/_ Ei
PRIMARY CONTACT: OWNER' CONTRACTOR 0 OTHER 0 = Z
NAME 5Ame, EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL D
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PARCEL INFORMATION: ,
PARCEL NUMBER(12 Digit Number) ZZOVI' 51- 0010 ZONING
LEGAL DESCRIPTION(Abbreviated)ia LOT I OF LLS *04-oz 5 34) YFIRE DISTRICT
SITE ADDRESS 101 S G K 1LILLM P . CITY 5NELTOI•I
DIRECTIONS TO SITE ADDRESS I N Tf_I_SPLI T1O n e::›F kP La It irl 4cync-H
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOV. SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW$ ADDITION 0 ALTERATION 0 REPAIR ElOTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc) RE 51 t En et.
IS USE: PRIMARY N. SEASONAL 0 NUMBER OF BEDROOMS_•'{ . NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(WholeBldg))4 YES(Part[s]of Bldg)❑ NO❑
DESCRIBE WORK N G vv GD n 5-n2.u.CT t on
SOUARE FOOTAGE:(proposed)
1ST FLOORV1 64 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK Gsq.ft. COVERED DECK I50 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE/�•I8'5 sq.ft. Attached Mg Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEWS EXISTING 0
PLUMBING IN STRUCTURE? YES X NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD . EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 1 TOTAL BEDROOMS 9
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.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 160 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATI OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
0
X I - 5- 2023
1 o ER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH tl-L7Ii3 tT .S GI.19-t44
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EH Setbacks , c.
A.) Drainfield/Reserve requires 10'setback from footing/foundations ;
B.)Septic tank(s)requires 5'setback from all footing/foundations �"- -"`- ..., 0 1 �; a
C.)No foundation/Perimeter Drains within 30ft,downgradient of I lc(
area Jto
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within CO r . r" �%
50ft,down gradient of Drainfield/Reserve area ( M'n ,
4'o b.p, -4,4 ,:
•
EH APPROVED ..4 a �` I i
Rhonda Thompson 01/27.'2023 .1-'
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Arrow Septic Design* 5o m;h e �.
171 E. Vuecrest Dr ,'1 . / / #'-_
Union, WA 98592 *;
• 360)89&2255 P VP,o
_2-25
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7 50'
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Key:
Audio-Visual Alarm
`.�`p�.�� .. N C Cleanout
zkt G PALue 1200 Gallon Septic Tank
'2.02�'3 ii lO 2-Compartment with
� �. Z» Effluent Filter
i.-.),(v_.1.+cik____, (31000 Gallon Pump Chamber
0 Valve Control Box