HomeMy WebLinkAboutWAI2023-00013 - WAI Health Waiver - 2/9/2023 `��{ F 't'1 \ 415 N.6'STREET,SHELTON WA 98584
MASON COUNTY SHELTON:360-427-9670,ext 400
" COMMUNITY SERVICES
W BELFAIR:360-275-4467,ext.400
ELMA: 360-482-5269,ext.400
r' Nd r Building,Planning,Environmental Health,Community Health
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Application for Waiver or Appeal
Amount Paid: Receipt Number: a16 •
WAl )' I" on 0 k3
Instructions:
1. Complete Parts 1 and 2. No determination can be made until these parts are fully completed.
2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule.
3. Submit completed application with attachments to Mason County Public Health for review.
PART 1. Applicant & Parcel Information
Name of Applicant RJ Peabody, Inc Telephone 253-514-3915
Mailing Address P.O. Box 565
City Burley, State WA Zip 98322
Parcel No. 1 2 3 3 0 _ 5 1 0 0 0 1 0
Site Address NE Galley Way, Belfair, WA
Subdivision Name and Lot Beards Cove/ Div 4/ Lot 10
PART 2: Nature of Waiver/Appeal
❑ Onsite: Class A Waiver 0 Food Sanitation Requirements
❑ Onsite: Class B Waiver 0 Group B Water System Regulations
❑ Onsite: Class C Waiver 0 Water Adequacy Requirements
Onsite: Location, WAC246-272A-0210 0 Building Permit: EH Review Policies
❑ Onsite: Holding Tank, WAC246-272A- 0 Appeal: Enforcement Timelines
0240 0 Appeal: Departmental Determinations
❑ Onsite: Contractor Certification 0 Other
Requirements
Description of Waiver/Appeal (include justification, additional material may be attached.).
Reduce horizontal separation between house foundation ao drairlf Wit.ig 10' to a minimum of 2'.
Mitigation Land slopes away from foundation. Drai ra• ' t 1 it .rM . ••. 14i•m foundation, not toward it.
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Applicant Signature: Date: 2--1- 7:
O riS ce-_ &mac- `'.>-- Arc- Ct,&,- Re ised 8/13/2018
This form may be scanned and available for public view on the Mason County Web site.
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PART 3: Public Health Evaluation (Staff Use Only) / 0 G '
1. Type of Determination Required: Type of Onsite Waiver (if applicable)
Appeal Waiver • None required I Class A Class B Class C
2. Identification of Specific Code/ Standard/ Determination (include date of determination or
latest Code/ Standard revision):
3. Nature of Appeal: /
(47 d d ulr✓ Z f l A-c 0( 7 'fi
4. Hearing Official:
❑ Board of Health 0 Health Officer
O Pollution Control hearing Board 0 Public Health Director
O Certified Contractor Review Board Environmental Health Manage
5. Mitigating Factors:
2 + M,/,n/l/`l^' / c.7Pt irr5-e
V ya 4-1 6/~ up JIB/
6. I have received this waiver/appeal request. It is complete and mitigation required by the
state and local policy has been submitted.
Staff Si nature: i Llf-ON----,, Date: ----2--3 `- .-
9 ,Q
PART 4: Determinati n of e Hearing Official
-The hearing official has determined that approval of this request will not adversely affect public
health and is hereby granted. This decision is based on the following findings and conditions:
0 The hearing official has determined that approval of this request could potentially adversely
effect public health and is hereby denied. This decision is based on the following findings and
conditions:
Health Official Signature: Q Date: 3/L / 1, 1
Revised 8/13/2018
This form may be scanned and available for public view on the Mason County Web site.
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