HomeMy WebLinkAboutBLD2023-00283 - BLD CD Environmental Health Review - 3/13/2023 IiQ+9ab�
;�:k_ - ; MASON COUNTY COMMUNITY SERVI Es Permit No 1.oa�a3 - ego ..B
/' i PERMIT ASSISTANCE CENTER: I�r.I\i r- :'a,
r r • a-�•a•EJ:L.^.;:.G•P._•.ti,Vi G•PUBLIC HEALTd•FRRE MARSH, ( Y...
615 W.Alder Street,Shelton,WA 98564
3,r • ;t+ Pho Lodi
• ne Sfiegon:(360)427-9610 est.352•Far.(360)427-Tt7d Phone t 1
_ .,1 Beilai,.(360)275-4467•Phone Elma.(360)482-5269 I't�itet� Si l��J �,C0
\ / BUILDING PERMIT APPLI �1
Alder StreetEpL
114
PROPERTY OWNER INFORMATION: I CONTRACTOR INFORMATION:
i 1 it ..I( i I o
NAME: % I y1 L L f� l Cv I NAME: Mt UwJLY'
MAILING ADDRESS: [, 1Ckiejssis,..zrMAI ING AT)DRESS: `
CITY STATE'� CITY: STATE: ZIP:
PHONE#1: 459 f 1! 7 PHONE: CELL:
PIIONE#2: / EMAIL:
EMAIL If rhe'i OA O C i)itij L&1 REG# _EXP. / I_
PRIMARY CONTACT: OWNER fil.14 CONTRACTOR fl OTHER n m �]
NAME �10 CPS 4)CcJ1't•F?1— EMAIL m
MAILING ADDRESS CITY STATE ZIPe. 00
PHONE CELL ITT1 1�
I`ARCEI.INFORMATION: CI --
PARCEL NUMBER(12 Digit Number) �I:t. (6 5 i ()co7, zONINCi
LEGAL DESCRiP yea) FIRE DISTB�ICT !
SITE ADDRESS • CTi r i roz fl S C.1•r
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300.FT OF SLOPE(S)GREATER THAN 14•h: N4 i
E( ) YESD SIVENV f•04D:�flsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheek all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM❑ I
TYPE OFWORK: VFW n AnniTTnx n AI•rwlrA-ryyd I i nEaAiR n nTtaco n
USE OF STRUCTURE aesldowq Garage.Camerae?Bldg,Fic.); :q,_i ge /cc t'
IS USE: PRIMARY 13,4EASONAL❑ NUMBER OF BEDROOMS_,. NUMBER OF BATHROOMS,e
, HEATED STRUCTURE? YES(W ok B141,Pr"YES(Punta)y(Nag)❑ NO❑ ;
DESCRIBE WORT( iiti( 4 1-t`-- e t in GUe "ilb 6 f__C ct t" ' G/1 l L" :
OUARE FOOTAGE:�� iram
1S!NLUO1I j q.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 0 Detached❑ CARPORT sq.ft. Attached❑ Detached gf
MANUFACTURED HOME INFORMATION: *4 COPIES F THE FLOOR PLAN REQUIRED*
j N. MAKE Q,y1G•life_ MODEL L 3 6 YEAR I q 9 LENGTH2%�! . z8 P
•-------
�.. '-J-,'ff_•_.. . .Y I.I.,aifr•.. . 7J
i:.I.DTH A.t.l\W1r1J ✓ i i11nJ 4JV SERIAL _._... . _ ____
_.,,• ,r�>�' tV 111V1tfbKl7UtJ T!�V /7 C V
9
ENVIRONMENTAL HEALTH:
•
SEWAGE/SEWER SOURCE: SEPTIC 11` SEWER❑ / NEW[] EXISTING.IV
PLUMBING IN STRUCTURE? YES t;. NO❑ dynes,attach completed Water Adequacy Form
-1 PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO[ - EXISTING SQ.FT.
`smz-c rmn.—'o s Z _ :::ia OSED DiiiRcx)i is / i v i iv,.iiiiiiiiOiiivi. i
OWNER ainaccurateowledaes that submission of inaccurate information may result In a stop work(/order or permit revocation.Acknow:edgcmcot of suds 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.t Isom
obtained permission from all the neceskny parties,Indudtng any easement holder or parties of interest regarding this project.The owner or legal
representotivc,represents that the inf:..r..tion provided is atlasrale end Wants employees of Mason County access to the above descdbea property
and structure(s)for review and inspection.This perndiappbcason becomes null&void if work or authonzed construction is not corrnenced 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
PFDMAIT ADDI N•ATKM!"F 1!! RAVR nF•oars••a•• r 5•,mr•T••r •ww••r •T•w..TO SE E.....RI..� (MASON
DE 14.08.42)�
Y �� �G/- -; `{ Z
ignature of NER( sit be snorted OWNER) Date
•DEPARTMENTAL REVIEW• APPROVED • DATE DENIED DATE TAGS/NOTES/CONDTTIONS
BUILDING DEPARTMENT
PT A\11RkTn nrrf.rsTS ir,.nr
FIRE MARSHAT.
PUBLIC HEALTH 1 12fe "41740 _I L( (?SnI /v\ F /A y
. , . . . . . . .
• . . . . . . .
. SL..0 aoa-o- c7cDaEz
4/ t-; ;
. . . ... . _... . . . . . .. . . .._.„ .
e
I e4...4. .
.,....._....,
• ,
i •, , I i
t il
. .
1 r: r.I 1 .,.. 1 ..0.. .•/ I e
I go, V
: 1
-...-...4... i
.. 1
. •
• . ;
•,:, .• i . .
• :,.., , ., i •
' Lk/C•ft''t' ;
•
. ;1
-..
`i:. ... •.:-44 I - .•e•a•,41,4,1.1 ,r
•,
'.1. _,..,r il,, ",.....:..-• , ;- ..
i .• -...... --- - ... --.—......,/ .
''.. • . . .
I . • .
\ 4 ••
•.
1 .,
. . i .
t v .., • . .
t
.. i .
. -rb,./,;/- .• ;
4
.' fil.4..: "••,•J, ';...t.•i•.: ',.. i , • • I
1 t! 1 - .. ...--.—..
4-: i
I. 1
' l'•:•. •li'
I- ;'t.,s." I I it
.
! ; •.. f• .-
\ 1 1 I '. ! i /!.../
. .
*, it,eke . ...
r
• ----1 - 1 Cover .
,1
F.-F -•-
1 , 1 ..,;„..," ..: j .- .... _, -; / •..--
il•.• t ..-..- : ,' • ,
...I^ .-
1 1 120:7 4
1 • •
i. ' '•-• ..............._._............
- -------- . .;
i t ,
. ;,),,...st)t 4,-• ..
\ •. ' • i' . .
1
.t
•1 T
t 1 4 i.;4, , ,k,
..,. i .
1 . : . .- L' .1 a I •
1 i.-........" I
1 . 3 4:::5 1:-• :','"!. 1
1 •
k 1 i.
k i 1 i
- •0 . i 114 iC' i(--',4.- ,--J3 kaik.e. Ct3s.1. iijotn
A.- 1
p(. ..!-- ..1 /..-:.....,--- --,-..-n--,,:., .. ;--,--. .----
, , ., . •• •• ...... ...,,..,
, .
•
EH APPROVED
Rhonda Thompson 04/27/2023 .. ,—
Ah)t-e : 11,-(6,fa/ COU6 r i..:, ,..)7 0 x i i I?
EH Setbacks
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
Drainfield/Reserve area.
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reserve area