HomeMy WebLinkAboutBLD2023-00620 - BLD CD Environmental Health Review - 6/6/2023 fr �:` _y'.„ MASON COUNTY
Permit No: i/I(I�U 2 2— v.�O
,,,,:- 4). , COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION `G , s
PROPERTY OWNER INFORMATION: CONTRACTOR iNFORMA iON: .d' 4/1, ;
NAME: ,6 ' ''L �L� I NAME:T over I C,J I. -eS / �CI, v
MAILLM SS: _ C!' MAIL .., ADD SS:J�SD MP ki4acy kit 1. r-••
CiTY:V�1tl STATE: CITY*illik- •!%) STATE: ZiP: 77 •O
PHONE#1: — PHONE:__12,'" • L: f z .:,,..0
PHONE#2: EMAIL: 01"'141 I.Cit,al
EMAiL: L&1 REG# EXP. / /_
PRIM CONTACT: OWNER❑ CONTRACTOR❑ ¢ HER ' D"
NAME ^ rs EMAIL t 1`r(-GI a.� 4I1'IQ� m O
MAILING DRESS CITY e►1 Q i,L STATE ZIP > a
PHONE . �� . CELL
PARCEL INFORMATION: 2 ���f
PARCEL NUMBER(12 Digit Number) C 13 -7&-Fee /' ZONING = L
LEGAL DESCRiPTTON(Aprsviatcsl�� ����� t r n` FIR iLSTR�1�� �^ _
SITE ADDRESSr V '1 (1��1( hDI IONS TO AD�s )4 / acir teocj Ie oG� r
ne1Fr IYIii I
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ietNOW LOAD psf
iS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM[I
TYPE OF WORK: NEW"ADDITION 0 ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) ,Re i.deli e‘e
IS USE: PRIMARY 2 SEASONAL❑ NUMBER OF BEDROOMS ✓ NUMBER OF BATHROOMS
HEATED STRUCTURE? YEk(Wh eBldg)V.—YES(Pants)of Bldg)❑ NO❑
DESCRIBE WORK f)Z 4-9 I Ii IA.07. taq(p 5� 40.en e SQUARE FOOTAGE:(prop.,.)
1ST FLOOR laq,.. sq.ft. 2ND FLOOR sq.ft 3RD FLOOR sq.ft. BASEMENT sq.II.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.IL OTHER sq.II.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED ED•
HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIR
MAKE ? "F7- i� MODEL?Q re.�/� YEAR LEND 1
WIDTH (1-1 BEDROOMS 3 BATHS 2- SERIAL NUMBER�E OS)
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW EXISTING❑
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO['' EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS (5 _ TOTAL BEDROOMS__ _
OWNER acknowledges that submission of inaccurate information may result In a stop work order or permit revocation.AdmoWedgement 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,inctudng 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 Courtly access to the above described property
and structure(s)for review and Inspection.This permit/application becomes null.1 void If work or authorized construction is not commenced within 180
days or d construction work is s.rspnnded fore period of 18D days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPUC F 1 0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
CODE 14.08.42)
Signature of OWNER(Must signed by the OWNER) Date
4 DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FiRE MARSHAL (� , Q
PUBLIC HEALTH 'QJe'S G14J(Zi C- °( 'alkb
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.: • ...• -:.: -• --$, ::.•-,....::..•.,,:.k,•,,. •••••,:Ai.,::- :.1:./. ''i.•-,- ; • ;,..•-, •-.:,'...pip,r.pacis 601•1'.1.
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.Planning setbacks. i ° '‹ , 4t .4 / 4. •»f. .r. .t} .. . ,
:ront 25 , . a �J r� 0 • : a._.::6 •
fides 20 �" / yqg ',
sear:20'' '•:':. •' :•'• :+; .: .,. l 'I, : .... .� ,.
all setbacks t,easured'*om the farthest s ' �'
irojection of.�ie buildiihgs. • :... ./. �,"'
subject tof': L^ics:.:: '
EH APPROVED.
� •Th /2 2023' M+:1 ,. .l�hortda ompsort O6 8( • lilt:
l
EMI S #backs ,�Y . ::;: .
AlDrainfield/Reseive i uire'40'setback;fram footi• foundations• .:• .. .. • . . -
B.)Septictank(s)•requires 5'a.t)iack'from alkfooting/folmdatioRg • • : . • • n' . : •
C.)Nn taf�daraziP9f Od er.► s in don rad=" • ? ,:'. . •',fir
Drainfield/Reservearea. •• ' •.r
D.)No Cut'Bank(s),(greater ah 5ft and,overd5,degrees)within ' • . .,• ' ' •• ' ':.:"_: `-.•''' -
50f1 down gradient of Drai eld/Reserve'area_• , x J: - ' ' -
730 �D K.
l.,
- :•' '•`•''':.:; ' . • :MASON:COUNTY.f toRONMENT4 HEALTH . .,
Printed •From::.Mason-�County DIMS•:' ''. : , ';,.ew-'•. -LP.•LN 'Approved .i
•
Printed from Mason:Count ICOA8• • •• Oti/08/2t12'3 -
Mason County Community Development
'Gavin Scouten
All Changes Subject to Approval