HomeMy WebLinkAboutBLD2023-00722 - BLD CD Environmental Health Review - 6/27/2023 �--� Pe• it No:7,161262.3 -00'T
MASON COUNTY
) COMMUNITY DEVELOPME , yeti .y C E I V E D
� ✓ Pc:rniL Assioial Cnter,Building,Planning IpF
BUILDING PERMIT APPLICATION Cc
10�� JU 6 2023
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMA Oi1:1 5 • . Alder Street
NAME:Debbie Haferkamp NAME:C.W.Harmon
MAILING ADDRESS:P.O.Box 754 MAILING ADDRESS:1281 W lost lake rd
CITY:tenino STATE:Wa ZIP:98589 CITY:Shelton STATE:`Ara ZIP:93584
PHONE#1:817-917-1912 PHONE: CELL: 253312-2065
PHONE#2: EMAIL:joioblackdog@gmail.com Ill
EMAIL:drsamoson@scattercreek.com L&I REG# EXP._/_/_ Z
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER 0
NAME 0.4H.m.'" EMAIL jojobladcdog@gmait.com
MAILING ADDRESS 1281 W lost lake rd CITY Swnon STATE Wa Z1P98584
PHONE CELL 253'312-2065 rTT_
Y
PARCEL INFORMATION: fl
PARCEL NUMBER(12 Digit Number)51901-50-02907 ZONINGR5 = rn
LEGAL DESCRIPTION(Abbreviated) Lost Lake BLK2 Lot 115 180'82 of N,60' FIRE DISTRICT
SITE ADDRESS811 w lakeside Dr CITY Shelton
DIRECTIONS TO SITE ADDRESS
r
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESQ NO❑ SNOW LOAD: pot
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW El ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage.Commercial Bldg.Etc.)
IS USE: PRIMARY❑ SEASONAL 0 NUMBER OF BEDROOMS V NUMBER OF BATHROOMS a
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Parris/ojBldg)0 NO 0
DESCRIBE WORK New Construction
SQUARE FOOTAGE:(proposed)
_1ST FLOOR 1196 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURE 1: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL AR LENGTH
W TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC El SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOB EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 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 descrited 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
COUNTY CODE 14.08.42)
X
Signature of OWNS (Must be igned by the OWN Dat
DEPARTMENTAL REVIEW / APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL 7 Ca/Wen �,,(�
PUBLIC HEALTH tr ! Ea/�(�G3 CMG -
J 2O tBv-, .,._.r....... --__
PLN Approved
07/10/2023 Planning Setbacks
Mason county Community Development Front: 25'
Gavin Scouten
Side: 20'
All Changes Subject to Approval �v a 1?J../ -�
Rear: 20
*all setbacks measured from the farthest
'.S'rJ' projection of the building
.._ *subject to EH setbacks
, :I) .,....
_ 1 1= 4a ray 5 /.0 p
._.____
Ste- t<.-, Pp . \ i
o 0 g ITlln :Jr.b �_r"
N -
,otter
riam,
•
' Qka ()r•.5t:?> st I
- l' — c`c ("s. ..,,,....L___
PROP SED GARGE NOT ‘..tt
.......$)
APPROV D WITH H THIS PERMIT
, I EH APPROVED
+. ,1 95 D.Anderson 08/22/2023
I U
`3� EH SETBj4CKS
���/� '( )Drainfield/Reserve requires t0'setbacyk from footing/foundations
'�"I C- -- fit, )Septic tanks)requires 5'setback fro all footing/(oundations
( h )No foundation/perimeter drains with 30'down-4radient of drainfield/
+' "t serve area
�`'���- 1 No cut(s),banks)(greater than S'St over 45 degrees)within 50'
.:,/ S — own-gradient of drainfield/reserve are
� � I _
_t
�J L 1
!) 10 q' E IP
1..... E II
1 1
..
_ ' i
>,
...... 1 ----------_, \ \..,,,
:___,.. .,.......
(bit u), L f\Ke- .,1 bc----D-R-.._-------
--' -dp-
, ,
—b1ct2023 - 00 ..'-7,A �_
aI , �.�1