HomeMy WebLinkAboutBLD2022-01249 - BLD CD Environmental Health Review - 9/22/2022 . �s.,.. k' rt� i MASON COUNTY COMMUNITY SERVICES Permit No:. I I �9
PERMIT ASSISTANCE CENTER: E G D
`i •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
y ■'I r'■ •i 615 W.Alder Street,Shelton,WA 98584
C- SEP 22 2022
-1, ✓""' ,- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
f�tO, ,�,+ •y Belfair.(360)275-4467•Phone Elma:(360)482-5269
�'rt�r��� 615 W. Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR/INFORMATION:7' rlv F I,
NAME: �,,y� A NAME: CCrt FS a� u0 Z
MAILIN DRESS: MAIL A Dr
: 1 16
11� � 5Q1
CITYD�q�� STATE: � ZIP:Mn...(*_ a � CITY: oa� STATE. (� ZIP:�$
PHONE#1: _j-1-3 2c PHONE:Z53 3\pl cn ELL:
PHONE#2: EMAIL : 5 lt`r 0.- c2_Q»Jwvo.A•ear.•
EMAIL: L&1 REG# EXP. /
PRIMARY CONTACT: OWNERS CONTRACTORS OTHER❑ Z
NAME 4Sj wo Off' c.7toV. EMAIL '�'�
MAILING ADDRESS CITY STATE ZIP P
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 1Z'2 \— .1-5 a 1001 1 ZONING
LEGAL DESCRIPTION(AbbreviatPrll Lo7": 4 rjp 7- Irv) AF #4%.3o3FIRE DISTRICT
SITE ADDRESS_,j i' .y _ C\Q\'t..,� f
9 C.. CITYR.)46.�o"‘b
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO,EJ SNOW LOAD:2psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK❑ POND ❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEWSADDITION 0 ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE (Residence,Garage,Commercial Bldg,Etc) ,/%
IS USE: PRIMARY,rSEASONAL ❑ NUMBER OF BEDROOMS ) NUMBER OF BATHROOMS Z f
HEATED STRUCTURE? YES(Whole Bldg) YES mails]of Bldg) ❑ NO 0
DESCRIBE WORK
SQUARE FOOTAGE: (proposed)
1ST FLOOR I(o20 sq.ft. 2ND FLOOR .N.ft. 3RD FLOOR sq. ft. BASEMENT sq.ft. t.
DECK sq.ft. COVERED DECK Lo 1- sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE cl e) '
sq�ft. Attached 0 Detached 0 CARPORT sq. ft. Attached❑ Detached 0
MANUFACTU RMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAK MODEL YEAR L
DTH BEDROOMS BATHS ER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEWS EXISTING 0
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED?
PROPOSED? YES,O NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 5
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
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-Parcel-# E2329-75- 90071
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EH APPROVED / •
Rhonda Thompson 62/24/2023
EH Setbacks �" /7
A.) Drainlield/Reserve requires 10'setback from footing/foundations • ) +T d'f f
B.)Septic tank(s)requires 5'setback from all footing/foundations
.......7,
C.)No foundation/Perimeter Drains within 30ft,downgradient of ;
Drainfield/Reserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within '
50fi,down gradient of Drainfield/Reserve area g� •^: v
50
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O Audio-Visual Alarm w .. �i. �;y
en t7can .� ,te a OSed
OCleanout \\_:i 3$R
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O1200 Gallon Septic Tank •-
�/ 2-Compartment with t-- j..
Effluent Filter _� f
4 1000 Gallon Pump Chamber •
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O Valve Control Box t ,r--------e" '
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