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HomeMy WebLinkAboutBLD2023-00011 - BLD CD Environmental Health Review - 1/5/2023 t • C,,;(;.PLi MASON COUNTY COMMUNITY SERVICES Permit Nd- �►�ti.'k-f_ \f ar)t I PERMIT ASSISTANCE CENTER: '''' 01117 '-; .,,`•BUILDING.PLANNING•PUBLIC HEALTH•FIRE MARSHAL • 05N ;). 615 W.Alder Street,Shelton,WA 98584 fl, z`i'- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone <1 3y BeBeltalr:(360)275.4467•Phone E/ma:(360)482-5269 615 W. Alder Street irr rn.t� BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:2X}1 PA e KE& NAME: MAILING ADDRESS:Ci 1 5ti KA L'rlAl MAILING ADDRESS: CITY;SI-If-L-TONI STATE:YVA ZIP�16. CITY: STATE: ZIP: PHONE#1: 3t!po- S P•(ODO PHONE: CELL: PHONE#2: EMAIL: EMAILdU IN y IA)5 ATt L yA}Wi L&I REG# EXP._I_j_ PRIMARY CONTACT: OWNER❑ CONTRACTOR 0 OTHER 0 NAME EMAIL MAILING ADDRESS CITY STATE ZIP PHONE CELL PARCEL INFORMATION: • PARCEL NUMBER(12 Digit Number) Z2_OZ9-3 4-Soo\D ZONING LEGAL DESCRIPTION(Abbreviated)1.OTf 1 OF t_LS 44o -o2 5 34/Z1 FIRE DISTRICT • SITE ADDRESS 10 t SF- KAL L.0 WI. C C . CITY 51-k�t,TOIJ DIRECTIONS TO SITE ADDRESS 1(\Te,e..5?!0.,-n On of g A L► LU'fl ff 1.4 n IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NOX SNOW LOAD:.__psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all dog apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0 TYPE OF WORK: NEW tg ADDITION 0 ALTERATION ("I D REPAIR❑ OTHER 0 USE OF STRUCTURE(Residence.Gauge,Conmrerc;al Bldg,DO) (�1 Y'�RA t, IS USE: PRIMARY, SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE'? YES(IVIole Bldg),❑ YESr , (((Pmr,(sjofBldg)❑ NOVODESCRIBE WORK ne,tt� ►wo•c�4 -LT10 n SOUARE FOOTAGE:(proposed) 1ST FLOOR sq.II. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.fl. GARAGECitei1) sq.ft. Attached 0 DetachedA CARPORT sq.ft. Attached 0 Detached 0 MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATIIS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW1 EXISTING 0 PLUMBING IN STRUCTURE? YES❑ NO' If yes,attach completed Water Adequacy Fornr PERIMETER/FOUNDATION DRAINS PROPOSED'? YES 0 NOO EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS OWNER acknowledges that submission of inaccurate Information may result in a slo 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 fora period of 180 days. PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) _____c_i____ _ Q cc---..) Signature of OWNER(Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL ( _ PUBLIC I IEALTII \17 Ti t ) C" -)+51 -", ar1k ^J r • 417. ,,, ,,,y • FPatLl2m..1' 0r�v—�� ODO►1 .% iilly-024.1 • TT y 1VAp N tLO 1r { E { ' 1 —� Welt t i ' 1 .1 I , EH Setbacks ç ! A.) Drainfield/Reserve requires 10'setback from footing/foundations i ' B.)Septic tank(s)requires 5'setback from all footing/foundations "-- —�� I`1 v.-- - c 0 C.)No foundation/Perimeter Drains within 30ft,downgradient of iL{ 10 Drainfield/Reserve area J `,,j D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within � K „: 50ft,down gradient of Drainfield/Reserve area 14r0 0.) EH APPROVED ti- Rhonda Thompson 01/27/2023 �' j. !!' ! 14 ' 4 if ..1 AITOW Septic 0' 171 E. Vuecrest DV 4,yt ,' , if--, .. '.�. Union, WA 98592 4 :.- .:..;t ': w.y:,8 ; .3�2023 . (360)898-2255 7 00010 / . ..fir 50' Key: / - 0 Audio-Visual Alarm L () �..PctJCleanout �.AP\ G 9AQ V 3 1200 Gallon Septic Tank � �� ,© 2-Compartment with Np}��2 G��. z�� Effluent Filter 14 `mot �)t v��'1 tie 3j woo Gallon Pump Chamber 0 Valve Control Box