HomeMy WebLinkAboutCOM2022-00099 - COM CD Environmental Health Review - 11/23/2022 ci�tx;1.; MASON COUNTY COMMUNITY SERVICES Permit No: (JD'l 2�— oDO�
J. PERMIT ASSISTANCE CENTER:
401111117
Ra •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL — I�,
615 W.Alder Street,Shelton,WA 98584 [L� r
\7 ".S Phone Shelton:(360)427-9670ext.352•Fax:(360)427-7798 Phone �'/\
' - Belfair.(360)2754467•Phone Elma:(360)482-5269
\ NOV 2 3 2Uu
BUILDING PERMIT APPLICATION � ,
PROPERTY OWNER INFORMATION: CONTRACTOR :Street ' 1
NAME: i�r-L i:50.-T 1ki>, -T wall /)L.iM t lt`--55 NAME:
MAILING ADDRESS: ZIOE: e-11,4.50 .'L .Ra• MAILING ADDRESS:
CITY:511-m1-tcn1 STATE: tr+'N ZIP:'b5-i`.j CITY: STATE: ZIP:
PHONE#1: 3L^0-y2_(e• i 3L 3 - 66L PHONE: CELL: '. 'yC N MENTAL
PHONE#2: 31c0- Z)9 — 4755 - ki•--i CY\ EMAIL: �i
EMAIL: ?ON(6 337 p vMAi I- •CCU:JA L&I REG# EXP.-/
H
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER Q'
NAME ..iM tit=<,S EMAIL 4n1lZ33-id C--76AA'L ' C.2itv1
MAILING ADDRESS 2t00 r• MASON L•12. 42.6• CITY She.I"re tit STATE i:JA- ZIP 9PiE31
PHONE CELL 3/DO- LI'4 - 47Y-5-
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3 a 12 7 -53 C 0 175 ZONING C'C.idC&C AL
LEGAL DESCRIPTION(Abbreviated) Lavtc 1, r&eOA UL- 4 T2hC-+ t7S FIRE DISTRICT
SITE ADDRESS Z IOC L- rv1h50N i-AtE. 1Z6• CITY 5 ke I f-cv+J
DIRECTIONS TO SITE ADDRESS
IS TIIE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO[f SNOW LOAD:lc psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND Q SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW[a' ADDITION❑ ALTERATION❑ REPAIR OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.))M lt'1l:Pt i,fk-.L 1q-
IS USE: PRIMARY[v]' SEASONAL 0 NUMBER OF BEDROOMS 0 NUMBER OF BATHROOMS 0
HEATED STRUCTURE? YES(Whole Bldg)g YES(Part(s)of Bldg)❑ NO 0
DESCRIBE WORK
SOUARE FOOTAGE: (proposed)
1ST FLOOR I fD 0 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 sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFJSEWER SOURCE: SEPTIC RI" SEWER 0 / NEW R❑' EXISTING❑
PLUMBING IN STRUCTURE? YES Vf NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOR' EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 0 TOTAL BEDROOMS 0
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 8 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 APPLICATION OF 180 DAYS F MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
C UNTY CODE 14.08.42)
X
igna ure of OWNER( ust b signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL (� r �\ j,n /j,��
PUBLIC HEALTH ►J , �I7j7i(13 ( V '1^' "S"�`)'
T • \ •
�LQT�LltN Q • •
s ��
T.
• AJNABLEMS.W.13,4WW--
..,..La3g23W's '00 l ��
• • f1- 5T�10O �i 'Pi
�,•-D-�,et°G$L -t ill Por�ls:Gts• j j j�iY \
4-0® GI' s0.007S,12-W • ® , _-
• G , � Np To i'1�•
•
-13" goo sr EH Setbacks � A(ebu- '
A.) Drainfield/Reserve requires 10'setback from footing/foundationsC
rf—
B.)Septic tank(s)requires 5'setback from all footing/foundations A -
C.)No foundation/Perimeter Drains within 30ft,downgradient of •
f L�
Drainfield/Reserve area
. ' D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
• 4 It. 50ft,down gradient of Drainfield/Reserve area
• J
AN q6
N-- rsd, EH APPROVED
Rhonda Thompson 03/22/2023
. N. ,
b rg.
l .p,roX.
aa,3t.'orL
ay. � exa5"-8
<< �-fS f( ,pra '
0 I`�1
98
1
• 30 11.1 H Otis e 1 Kev:
• 14 Shoo y�ca�e f O Audio-Visual Alarm
24
32 . • Q Cleanout
New •
1200 Gallon Septic Tank
Cake 2 Compartment with
/Ai' 'i •nd J 6'' v)e'Ve Effluent Filter
6Z, /4 ►PAIric, O '��SeJ Nev.)AS' '� �/ Q j,..,�„�.3-' - '� d
42) 0 7o,,, - l2-ao G..l.
m sb"G •
/ j344 jifk`she "
L S' / 1`
i• PAOLA JOY JOHNSON .. ` k