HomeMy WebLinkAboutBLD2023-00419 - BLD CD Environmental Health Review - 4/20/2023 �,‘vg"""'-'-'-- ,, MASON COUNTY COMMUNITY SERVICES Permit NO IGI 2D23-004 Iel
c.\ PERMIT ASSISTANCE CENTER: RECEIVED
f, •\•BUILDING••PLANNING•PUBLIC HEALTH•FIRE MARSHAL
•I I- !I 615 W.Alder Street.Shelton,WA 98584 :=�
,'' �_.j.l Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
MAR 1 3 2023
Belfair:(360)275-4467•Phone Elma:(360)482-5269
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BUILDING PERMIT APPLICATION 615 W. Alder Str et 1473
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: RECE/vEp
NAME: 0 t t NAME: .4 U t.�
MAIL G ADDRE S: MAIL I G ADDRESS:
CITY: STATE ZIP. CITY 1 s PHONE: ,9 STAT-: Z .
PHONE#I: S 3L.n
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�i.3.. 3 72-PHONE#2: EMAIL: z
EMAIL: CGP') L&I REG#DYY1L44r l✓_t .l l
PRIMARY CONTACT: OWNER K CONTRACTOR/ ►lP OTHER _f l/1^ m`. m DO
NAME (�
MAILING AD ESS S _ CITY �)�L � STATE WIA• zrt. R,33 ZZ PHONE 7 3 5114 CELL25-3 514 391S Y�teq ct�, > z
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PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 12.3 51 0001 O ZONING Z
LEGAL DESCRIPTION(Abbreviated)13e.04,1-('1 C btu L i*1 C) F DISTRICT
SITE ADDRESS 2O CITY D
DIRECTIONS TO SITE ADDS S r
4o YIV- an as e -
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEWX ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc)
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS oZ
HEATED STRUCTURE? YES(Whole Bldg)0. YES(Part(s)of Bldg)0 NO 0
DESCRIBE WORK 11E1/i Sci
SOUARE FOOTAGE:(proposed)
1ST FLOOR (.00 sq.ft. 2ND FLOOR$20 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK "Ls sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 416 sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
4 MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEP'TII[C SEWER 0 / NEW EXISTING 0
PLUMBING IN STRUCTURE? YESs. NO 0 if yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION D ttJJ��//PROPOSED? YES❑ NOpV EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 T TOTAL BEDROOMS "3
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 are 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&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 F 1 AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) 69
Signature of O NER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT �
FIRE MARSHAL
PUBLIC HEALTH Xf IL I(ZS ''() 4`�5QQ�"`
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ppQp5ec? • 0 Audio-Visual Alarm
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per\VE v\JA 1 CD Cleanout
PRPOc• D Ala I
YJ A--' L .� \I O 1200 Gallon Septic Tank
WE 2-Compartment with
G �J.��� Effluent Filter
r� y W Al ,-
04 1000 Gallon Pump Chamber
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--. 100' stream buffer edge
Arrow Septic Designs
171 E. Vuecrest Dr
totes: Union. WA 98592
. Stream is 51 to 58 feet east of the property. (360) 898-2255
House is 51 feet from the east property line.
Primary drainfield is 66 feet from the east property line. EH Setbacks
A.) Drainfield/Reserve requires 10'setback from tooting/foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations
Ecological Land Services, Inc C.)No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
1/23/23 EH APPROVED D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
Joanne Bartlett 50ft,down gradient of Drainfield/Reserve area
Rhonda Thompson 04/27/2023