HomeMy WebLinkAboutBLD2023-00707 - BLD CD Environmental Health Review - 6/23/2023 4 MASON COUNTY COMMUNITY SERVICES Permit No: b. t �
!' ., r. PERMIT ASSISTANCE CENTER: E D
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL R
.q Hito' 615 W.Alder Street,Shelton,WA 98584
YY " '`- - , Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7796 Phone J U N 2 2 2023
`4�' $'4Y Bel/air(360)275-4467•Phone Elm:(360)482-5269
BUILDING PERMIT APPLICATI 5 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
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NAME:� 1 ()rr S. ' bolle4irc,n , 'fi)tYes NAME:
MAILING ADDRESS: 21i p 9.0pbynf- AcA. MAILING ADDRESS: C
CITY:�eVic✓ STATt:t tA— ZIP:49cti(� CITY: STATE: ZIP: A Z n m
PHONE#1: an,L..)222—fa lc — PHONE: CELL: UM Z
PHONE#2:(Ua�j�r vsa3 EMAIL: C—rn<
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EMAIL:j -. S4-ew,,TarrtS6, mei.;(_c�.v. L&I REG# EXP._1_ N L� C
PRIMARY CONTACT: OWNER❑ CONTRACTOR 0 OTHER 0 D r� = DO
NAME -h?tie n rzxr..c EMAIL w m 0
MAILING ADDRESS 2 i i C--`Ac th..2 ArA- CITY [it(7i e•-•<-e-J STATE ZIP D Q
PHONE CELL ��'�
PARCEL INFORMATION: = m
PARCEL NUMBER(12 Digit Number) Z Zt-2----._ 7c ' Ot 2.0 ZONING . Z
LEGAL DESCRIPTION(Abbreviated)1 FIRE j ISTRICT "i
SITE ADDRESS .2 i I E. .bb I i' 2 e) CITY 6:10 pl-1) 1�1/1}
DIRECTIONS TO SITE ADDRESS
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 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEVki ADDITION❑ ALTERATION 0 7y REPAIR_ ❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) e{FY(i&i Du..
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS I NUMBER OF BATHROOMS I _
HEATED STRUCTURE? YES(Whole Bldg){p' YES(Partisj of Bldg)) NO 0 (_
DESCRIBE WORK PQfnVe'( 1 -k_A e L.VIC�VJ n(i1 !\_i'1ll
/x1Q, - Llvtry -j'Vbiti i
I
SQUARE FOOTAGE: (proposed) _
1ST FLOOR sq.ft. 2ND FLOOR 52b sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK Lap sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE-`7Zt) sq.ft. Attached*Detached 0 CARPORT sq.ft. Attached❑ Detached❑
MANUFACT MATION: *4 COPIES OF THE FLOOR PLAN REQUIRE
MA E/. MODEL YEAR LENGTH
rIDTH BEDROOMS BATHS iai u� t..;,BER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES NO❑ jyes,attach completed Water Adequacy Form IJJ W26:;-' (0335
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD EXISTING SQ.FT.
EXISTING BEDROOMS Z.. PROPOSED BEDROOMS 1 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 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 APPLICATIO OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Sicirtelnre-ofOWNER(Must be signed by the OWNER) Date
• DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH lk5r 7r?k3 3iLt- `ah 6:1>C\` )
r
211 E. Robbins Rd . Grapeview, WA 98546
Parcel # 22123-75-90020
125' f►
•
A.
F4 . Scale: 1" = 40'
4 Hzo
<c., ie
,
Oc\
125' • a
a EH APPROVED
with reserve `._,�.
,' (see scanned records) Rhonda Thompson 07/07/2023
:�Existing s.
. '')G12D277, dUtiOI
Drain Field
266'
' _ —►
Proposed
Existing Driveway I Garage
�tL_ _65' ►r
�Q
44-25' : Existing /f 6/ i
• Residence /ater SDurce • Heavily
Wooded Area
g 2200 sq ft
•
Existing
. 117'
43 Septic Storm Water
t Tanks
Run-off Path
•
63'
210' ►.
• • «< :
4Q .Bl.. . . .
twater
0 W • 13ft
_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