HomeMy WebLinkAboutSWG2020-00180 APPLICATION FOR EXTENSION - SWG Application - 5/5/2023 ON,
584
(11'
MASON COUNTY415 N 6TH STREET,SHELT967 ,E 98400SHELTON:360 427-9670,EXT 400
LFAIR:360-275-4467,EXT 400
,t BE ELMA:360-482 5269,EXT 400
• Public Health & Human Services
. ' FAX:360-427-7787
On-Site Sewage System Permit: SWG2020-00180
APPLICANT CORBIN & ABIGAIL CRAIG Phone: 360-490-7096
Address: PO BOX 741 UNION, WA 98592
OWNER JOHNSON TRSES RICHARD EST& Phone:
JOYCELYN
Address: RICHARD & JOYCELYN JOHNSON RL FAMILY TRST UNION, WA 98592
SEPTIC DESIGNER PAULA JOHNSON -Arrow Septic Phone: 360-898-2255
Designs Inc.
Address: 171 E VUECREST DRIVE UNION, WA 98592
Site Address: E Union Ridge Rd
Primary Parcel Number: 321067590162
Permit Description: NEW SFR -4BR - Pressure
Permit Submitted Date: 05/06/2020
Permit Issued Date: 05/18/2020
Issued By: Jeff Wilmoth
Current Permit Fees Paid: $625.00 (additional fees may be required upon installation of system).
Permit Expiration Date: 05/06/2024 (based on date of inspection)
Permit Conditions:
1 Permit must be installed by a Mason County Certified Installer unless prior written
authorization from Mason County is obtained.
2 Drain field installation not to exceed designed upslope and downslope depth specified on
design form.
3 Installer is responsible for obtaining Mason County installation approval prior to backfill of
system components.
4 Installer is responsible for obtaining Septic Designer/Engineer installation approval prior to
backfill of system components.
5 Mason County Asbuilt Form, Record Drawing, and Installation fee must be submitted for
final installation approval.
THIS PERMIT MUST BE ONSITE DURING INSTALLATION OF OSS.
PROPERTY OWNERS ARE RESPONSIBLE FOR DETERMINING AND MARKING ALL PROPERTY LINE AND EASEMENT LOCATIONS.
THIS PERMIT MAY BE REVOKED IF THE SITE CONDITIONS HAVE CHANGED SINCE THE SITE WAS INSPECTED AND DESIGN APPROVED.
FINAL INSTALLATION APPROVAL IS REQUIRED PRIOR TO TEMPORARY OR FINAL OCCUPANCY OF ANY RELATED STRUCTURES.
For Final Inspection visit: masoncountywa.gov/health/environmental/onsite/oss-inspection-request.php or call:
360-427-9670, extension 400.
MASON COUNTY 415 N 6TH STREET,SHELTON WA 98584
(.' SHELTON: 360-427-9670, EXT. 400
) COMMUNTI'Y SERVICES BELFAIR: 360-275-4467, EXT.400
-. = ELMA: 360-482-5269, EXT.400
Building Planning,Environmental Health,Community Health
,,. FAX: 360-427-7798
• APPLICATION FOR EXTENSION
Amount Paid: /610-- /
Receipt Number: 202- ` 1 2 A/8
o �
Instructions: Complete Parts 1 and 2. Submit application with extension permit fee. ke cheek p le to
Mason County Treasurer. Staff will review your application and determine if the extensi can d. If
approved, the permit may be extended for up to one additional year from the original expi tion
Extensions must be applied for prior to original expiration date. Multiple extension n a single permit
will not be approved (one per design/permit).
PART 1: APPLICANT AND PARCEL INFORMATION
Name of Applicant: AO 1 'tC9Y I Y\ C{011 Phone:(300) 'IRO—1 0 Ctlp
Mailing Address of Applicant: 53 E L.v\AOn Q cye k
City: otylAOh State: WA Zip: 85
12-digit Tax Parcel Number: 3D-kO(0 1 ctdt `p2
Site Address: S�J E Unton t-1 a g e Kd
Permit Number: SWG 00 i 8.0
PART 2: EXPLAIN WHY YOU NEED AN EXTENSION.
S e WAR of oL cA ce o wksL Lot l%(1.1 YvkO v a +0
.
P ic o p e,Y'�-.a \ a o 2.3 S e. Si-ad l Cot
.S0 0r 1 bU- a- -- ,r Sc.:AG iqn t,\k f. it.c5 5 ( of Zo2j .
PART 3: HEALTH DEPARTMENT DETERMINATION (staff use only)
❑ Extension Denied /,
Extension Approved New Expiration Date: 5— UG - 2
omments:
Environmental Health Specialist Signature: a
This form may be scanned and available f r public view on the Mason County Web site.
Revised: 12/13/2019