HomeMy WebLinkAboutWAI2023-00083 - WAI Health Waiver 415 N 6TH STREET, SHELTON,WA 98584
MASON COUNTY SHELTON: 360-427-4467, EXT 400
BELFAIR: 360 275 4467, EXT 400
4111M. - Public Health & Human Services ELMA:360-482-5269, EXT400
FAX:360-427-7787
RONALD BROWN
531 SE MORGAN RD
SHELTON, WA 98584
Applicant: RONALD BROWN
Parcel Owner: RONALD BROWN
Site Address: 531 SE Morgan Rd
Primary Parcel Number: 320245100016
Waiver Request Number: WAI2023-00083
Waiver Description: Building Permit: EH Review Policies
Waiver Submitted Date: 08/18/2023
Waiver Review Date: 8/31/ZOa3
Waiver Status: 40 ft)Vett
If you have questions or concerns let us know.
Sincerely,
David nderson
360-427-9670 Ext.353
danderson@masoncountywa.gov
WA ?03 -00033
MASON COUNTY .
_ AUG 141023
COMMUNITY SERVICES
\r RE
'' . \ Building,Planning,Environmental Health,Community Health CEIVED
��,.ItlIV'd\\
415 N 6th Street, Bldg 8, Shelton WA 98584,
Shelton: (360) 427-9670 ext 400 Belfair: (360) 275-4467 ext 400 Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid: \"\n 2 � II T rj lE E u[}�
I
Receipt Number: �V'' O J AL%
AUG 1 * 2023
Instructions - -J
1. Complete Parts 1 and 2. No determination can be made until this arts are fully c rg)ileted. __
2.2. Fees may be billed for waivers and appeals, based on the Environmental Health Fee Schedule.
3. Submit completed application with attachments to Mason County Public Health for review.
PART 1. Applicant/Parcel Identification 1,1MGA-We 1 U
Name of Applicant 11 I ►�el phone ' 7��— ��7 3
Mailing Address of Applicant 513/ ,4' e il,,, �,,,,,, O, `D
City lke,/t --) (ix- �J�'• State Z- Zip / 17
12-digit Tax Parcel No. 3 02 ? -- I -- D D 0 I
Site Address 5 ,I.S. -19/1‘21-Gp4 Z. Od• .-
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ Class B Reduction in Vertical (Installer, Pumper, O&M Specialists)
❑ Separation 0 Food Sanitation Requirements
Building Permit Review Policies 0 Group B Water System Regulations
Location, WAC 246-272A-0210 0 Water Adequacy Requirements
O Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
O Mason County Onsite Standards 0 Departmental Determinations
0 Other
D-scription of Waiver/Appeal (include justification, additional material may be attached.):
A...i L • i • , ` .. iLd . IA. / 2.!. ...' •..,l//
i
Applicant Signature: t 2'2U " '24J Date:dell ! Q/A�i
J:\L'1i Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 1 of 2
PART 3: Public Health Evaluation (Staff Use Only) LGCQ'f i-zil►7
1. Type of Determination Required: Type of Onsite Waiver(if applicable)
Appeal XWaiver n None required Class A i Class B Class C
2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/
Standard revision)
3. Natu ��oj�Appeal:
KCM/G& hare'z�1 Sri/ Sf q�On f weP�n elect. 4o tts
SCp C- 0r S y Z
4. Hearing Official:
❑ Board of Health 0 Health Officer
O Pollution Control hearing Board 0 Public Health Director
❑ Certified Contractor Review Board X Environmental Health Manager
5. Mitigating Facto s:71A1 CN't'i n0 J upo�-/,w f � -/hp ,�G (C
I�Gk actors:
S r Gl
6. I have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been su itted. /zo
Staff Signature: Date: v
PART 4: Determination of the Hearing Official
The hearing official has determined that approval of this request will not adversely affect public health and
is hereby granted. This decision is based on the following findings and conditions:
0 The hearing official has determined that approval of this request could potentially adversely effect public
health and is hereby denied. This decision is based on the following findings and conditions:
Hearing Official Signature: V1/4Date: v f f/ 1-0
J:\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2
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