HomeMy WebLinkAboutBLD2023-00272 - BLD CD Environmental Health Review - 3/15/2023 Ty OWNER INFORMATION: CONTRACTOR INFORMATION7:/�
B1 ro J NAME: (JUQOwR:70 OO i a,
.NG ADDRESS: P.Z. BK. (.211 MAILING ADDRESS:
ir: 0 port- STATE: vJ P, LIP:A5P5SS CITY: STATE: ZIP:
rIONE#1: 3 Lt7— 4-'70 --`N 3 j PHONE: CELL:
PHONE#2: EMAIL :
EMAIL: Pxckecbc (I7t1 e_ G F• I L&I REG# EXP.
e r'"
PRIMARY CONTACT: OWNER(� CONTRACTOR❑ O `�i �'L3.
NAME ��j COY\ (t 1 e r EMAIL �" --73 - m
MAILING ADDRESS a x .�. r�i1 TA .CITY TE ZIP T -
PHONE CELL � Stre `r
ENVIF ONMENTet my w
PARCEL INFORMATION: uu==__�� A L
PARCEL NUMBER(12 Digit Number) 1 ..z2.i t,>'.5/- O O/6 5 zbixEi4 LT H
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS CO Al. AJkc: e z eve 4 CITY i'koe-/S o t
RECTION TO SITE ADDRESS �-r.> O u r ' Lc
•
Likc Sc . L c4 ,.n Kpcc(A iI e (L• 1r ( Iaav'—,v) Ao can .1T-e L t c k.s;i"-tin, C e-e4
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES El NO x
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW '' ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑ f
USE OF STRUCTURE (Residence,Garage,Commercial Bldg,Etc.) RV . ( Jve)r- �0, X l4L
IS USE: PRIMARY X SEASONAL ❑ NUMBER OF BEDROOMS -!' NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(Part[s]of Bldg) ❑ NON,
DESCRIBE WORK 2U
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/11.0 sq.ft. N1
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq. ft. Attached❑ Detached 63
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 g[ SEWER❑ / NEW ❑ EXISTINGX.
--6
PLUMBING IN STRUCTURE? YES ❑ NO/4 If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS p
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
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 OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
/1 I COUNTY CODE 14.08.42)
pet4 ti•
Si lure of OWNER Must�signed by the OWNER)
/ Date
9 �
--- -
EH Setbacks EH APPROVED
A.) Drainfield/Reserve requires 10'setback from footing/foundations Rhonda Thompson 04/28/2023
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 1 - 1
50ft,down gradient of Drainfield/Reserve area 10 to*.1.I' f'0.5 'h1G"L
i i /I
m'
— — y 5, 6 ____ ____.., 1,4„._ Afi-- — -'--- •
a S,
A-- \ tox70,
, i 6 1
y k ,
If Iv-cisvot-•/
gov- Jr.__ r dye,:, 0,3.0
C bUCf •
-.:� rii." fr)( (aa 1
..._____- , \ i
/7.__,-- Lk{iliti .
e SCnter k r eG
/ /
(st 1
� � '/-- ' /1 l.4.,.__ i
fka / 1
� t I
;I - -191
I 1k . _ .., / /II NOVtll
NI". 1211
f'ivar , 1,..laelcifr CtAV
C' A7‘i -- 1414oti ce
TOPOGRAPHY PROFILE: f
(�.) 4�own jp .,.5 t—r., f;p1441 ,6i4di5 Px-4e-ci 4.1, V(q -/:ux rP Vera. /
Direction: 14o1-1-1n Scale: Approval: kw ot>i ce use
Guiding Permit number: D
4,'r•et 4 )0 Building:
Owner/Appicant 1
�,. 1Ce,r Date of Planning:
applcor>t Env. Heath:
Parcel Number. _/1.L_1O 5�X2/ j ` -- /�,�/-j-- -}