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BLD2023-00010 - BLD CD Environmental Health Review - 1/5/2023 (2)
.c•PL(4 MASON COUNTY COMMUNITY SERVICES P I CVOI U •i°� • PERMIT ASSISTANCE CENTER: L I•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL " I I. '° 615 W.Alder Street,Shelton,WA 98584 `r ` :f Shelton:(360)427-9670 ext.352•Fax:(360)427-7798Phone (� JAN 05 ivi� �y, .°'~ 4 Phone Belfair:(360)275-4467•Phone Elma:(360)482-5269 rco•i iti,V.' BUILDING PERMIT APPLICATI& 5 W. Alder Street FT1 PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: Z NAME: C QI24 1 C•-I P A Q K.Ef, NAME: 4 1 MAILING ADDRESS:91 Se, I�(.ALI U IA be MAILING ADDRESS: = Z CITY:5AELTO)J STATE.M A ZIP:16554 CITY: STATE: ZIP: m 0 PHONE#1: 54p0• 5CJ Ip• woo PHONE: CELL: > 2 PHONE#2: EMIR EMAIL:Su. NF,A•ii l� (A�1/_>4�(0�• L&I REG# EXP. 1 /_ El PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER❑ ' NAME SAME. EMAIL MAILING ADDRESS CITY STATE ZIP PHONE CELL D r PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) ZZO Zei' 39-'fJ 0010 ZONING LEGAL DESCRIPTION(Abbreviated)LOT I DF LI.5 4`04-02. 5 3,04/ IRE DISTRICT SITE ADDRESS 10 I S E. K.A Litt al e• / CITY 514E LTO1`-1 DIRECTIONS TO SITE ADDRESS I N-r it T 1 O n L-1. IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NO' SNOW LOAD:_psf _ IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0 TYPE OF WORK: NEW$ ADDITION❑ ALTERATION❑ REPAIR� ` 0 OTHER 0 RTI✓ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) 1 D En I a L IS USE: PRIMARY/2( SEASONAL 0 NUMBER OF BEDROOMS_H , NUMBER OF BATHROOMS 3 HEATED STRUCTURE? YES(Whole Bldg)X YES(Peril's]of Bldg)❑ NO❑ , DESCRIBE WORK ni 6. Ai (fon5"f12LICT1on SOUARE FOOTAGE:(proposed) 1ST FLOORZ 1 a-4-sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERED DECK IS0 sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE85 sq.ft. Attached ig Detached❑ CARPORT sq.ft. Attached 0 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 0 / NEWX EXISTING 0 PLUMBING IN STRUCTURE? YESN NO 0 If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS 4TOTAL BEDROOMS LI 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 180 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) X 0 - i tifre'ofOWNER(Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL ^M,� G ,, t, {� PUBLIC HEALTH al-i i k'3 (JC��ctT�M, ;�P�I'.JJn�_1I ..... tot 5 EL 1--Ai--t�.c--'- 02-k.r -- O0011 111:9-124.1 . - 11 .� 11 ' N r►�hllr. I 1 # well- ° EH Setbacks l'l 1 A.) Drainfield/Reserve requires 10'setback from footing/foundations B.)Septic tank(s)requires 5'setback from all footing/foundations -"'" r r "-----., 0 ,......„,1 c 0 C.)No foundation/Perimeter Drains within 30ft,downgradient o 10 f Drainfield/Reserve area 1 1� - ('4 D.) No Cut Bank(s)(greater than 5ft and over 45 degrees)within i � 1 50ft,down gradient of Drainfield/Reserve area Id MGM (3) ' ' 3-o p.F- ? it, EH APPROVED 4A A�•;�. �it� . 4W• � '-+ 1 Rhonda Thompson 01;27,'2023 fir, `l _ r, r Arrow Septic esigns 50'rvun g . . • ', . I !? r., 171 E. Vuecrest Dr 4-a .t - ;!a. ••: f ,. Union, WA 98592 •e� 1 "r r `,:. -aiici 2023 1,360)898-2255 r :, R ' ,• ., ... poOi o • ` b. • 7,• / „r. • • Key: 0Audio-Visual Alarm PLO-V L. N (:) Cleanout CiP-ptt G 1PAP--kk (� 1200 Galleon Septic Tank 3�� �O `-� 2-Compartment with 1_ z.'2/-02©t J`�4© Effluent Filter ct_O �1. 11- c)iu'c`Y-1 I��' 1 4, 1000 Gallon Pump Chamber 0 Valve Control Box