HomeMy WebLinkAboutBLD2023-00032 - BLD CD Environmental Health Review - 1/11/2023 ;. N ,ovy- MASON COUNTY COMMUNITY SERVICES
v 'F PERMIT ASSISTANCE CENTER: Permit No (Gi �y� i
�:7•y� .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL i . t !�
615 W.Alder Street,Shelton,WA 98584 e`"'
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Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone J AN �l��
Belfair. (360)275-4467•Phone Elma:(360)482-5269
_____)
615 W. Alder Street
, 1U 4 BUILDING PERMIT APPLICATION r.1
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: `
NAME: -'T('aJ l S Sc --0' NAME: g.i
MAILING ADDRESS: Zk) (e'j' (a4 i- MAILING ADDRESS:
CITY: S L.//t-r\ STATE: k ZIP: ?� '1S 9 CITY: STATE: ZIP: d
PHONE#1: goo -6 2.- -537c PHONE: CELL: L
PHONE#2: f EMAIL : R _
EMAIL: �ia.i=›.,Sc-I+u }-& yaizo .cO L&I REG# EXP. / /
PRIMARY CONTACT•4 OWNER ice/ CONTRACTOR❑ OTHER III 1-U
NAME `�cG,-‘s .-to i EMAIL -freeo1,.Sc -)--k7 y4 k•c .cam
MAILING ADDRESS 2til SE L{S4cy (C-=t CITY Sket , STATE -I i� ZIP 5',5-71'1
PHONE '�v o— Co Z-3•..fl?� CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 319 113 1 00 D Z'O ZORNG k PS 13 e,ti l \...)
LEGAL DESCRIPTION(Abbreviated)Pa 2.EF b\q 13--°I 4-'4200SS240 PTN1 ccSw )ISTRICT 0 —‹
SITE ADDRESS Z'lt SE L'SG r 1 Lc'--I - CITY S1 e 1/4-'
DIRECTIONS dP
TO SITE ADDRESS TVr.., s..1.1 ,SE c�o�•I c- Z a a r)^ (3 k i 1-t a^`) /`� ` if C t
I)pioeC (yeiJils 09Qi� ,o --r Lpf6c..f, Lc., . 1/1/ A,.l( a_dk- S
c)ei" �4, 1.
I � 14l'.) vot`' e/
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): ir-
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW K ADDITION ❑ ALTERATION 0 REPAIR ❑ OTHER ❑
k;
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) I.r?fe o r 1
IS USE: PRIMARY K SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS (I\
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES (Part[s]of Bldg) ❑ NC 1
DESCRIBE WORK B".‘e) Caro r F -C�r (ou-z^(.._) 7a,—LLti, Z
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR sq.ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK sq. ft. COVERED DECK sq. ft. STORAGE sq. ft. OTHER sq.ft.
GARAGE sq. ft. Attached❑ Detached❑ CARPORT IISZ sq. ft. Attached Detached❑ i'
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 1 ( SEWER❑ / NEW V EXISTII`P,n
PLUMBING IN STRUCTURE? YES ❑ NO/SI If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION D S PROPOSED? YES ❑ NA EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS______O__ — TOTAL BEDROOMS
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
I
• A .
. EH APPROVED
' Rhonda Thompson 03/09/2023 New 4 Bedroom 055 with
Details on Page 2
• EH Setbacks m .
A.) Drainfield/Reserve requires 10''setback from footing/foundations . -
B.)Septic tank(s)requires 5'setback from all footing/foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of
DrainfieldiReserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reserve area
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