HomeMy WebLinkAboutBLD2023-00407 - BLD CD Environmental Health Review - 4/18/2023 Permit No:l�) 1(1 G.c A - C I G i-
r MASON COUNTY RECEIVED
_ COMMUNITY DEVELOPMENT
�t r Permit Assistance Center,Building,Planning APR 17 2023
BUILDING PERMIT APPLICATION 5 1/1/ Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:John Stewart NAME: __ __ __ A _ rn
MAILING ADDRES'88 tillicum Beach Lane MAILING ADDRESS: z
CITY:Shelton STATE:We ZIP:98584 CITY: ST/ E: ZIP: _
PHONE#1:360 790 1673 PHONE: CELL:
PHONE#2: EMAIL:
EMAIL:Iohnfromboston55@gmail.com L&I REG# EXP._/_/_ rn 0
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER❑ > z
NAME sd,nsr n EMAIL Johnfromboston@gmail.com
MAILING ADDRESS 88 Tillicum Beach Lane CITY shoo. STATE WA ZIP 98584 = rn
07
PHONE 3680167i CELL z
PARCEL INFORMATION: i-
PARCEL NUMBER(12 Digit Number)42226'50-00001 ZONING R 's
LEGAL DESCRIPTION(Abbreviated)TPN 42226-50-00001 FIRE DISTRICT 10 44
SITE ADDRESS88 N TILLICUM BEACH LN,SHELTON 98584 CITY 41 /
DIRECTIONS TO SITE ADDRESS HIWAY 101 NORTH TO TILLICUM BEACH RIGHT INTO BEACH LANE HOUSE ON LEFT CC CP
`�2 Q(Q
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD:•OS9 osf I.
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
I TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 OTHER F1
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)residence
IS USE: PRIMARY 8 SEASONAL❑ NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Pori[sj of Bldg/Q NO 0
iDESCRIBE WORKtear down exsisting home rebuild on same site
SQUARE FOOTAGE:(proposed)
1ST FLOOR648 sq.R 2ND FLOOR1088 sq.ft. 3RD FLOOR" sq.ft. BASEMENT" sq.ft.
DECKwA sq.ft. COVERED DECK" sq.ft. STORAGE" sq.ft. OTHER" sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT N/A sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.
EXISTING BEDROOMS O PROPOSED BEDROOM: I TOTAL BEDROOMS
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
P IT APPLICATION OF 180 AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) ,,I
x 41- 1-1 . ?c '7
i nature of OWNER(Must be signed by the OWNER) Date
D ARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
B ILDING DEPARTMENT
-
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH OP Worn orntoseits, aeke
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THURSTON.-MASON DISTRICT HEALTH DEPARTMENT _ - -
DIVISION OF SANITATION ...
Court House Annex Court House Annex'
Shelton, Washington Olympia, Washington
Roane: 426..8515 • .Phone: 352-1a.851' -__
APPLICATION TO CONSTRUCT CR.ALTEtR AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM
(Application Required for Each Installation)
' LYE. . �J7 i4 C. Y Telephone $ -J 0 d
Property owner �(�, C
` , sJ� •
I_-�ease .P �) Address of Site/�AL L/&2fl ,�C� C 71
Mailing Address "-"''-' �Q �
Location of Property, Inc ud�g: Lot #Block # 1 Other '
(Detailed directions. to site)' _ The ,vc.7hetyr yi- .l 4.7" A,- _/ - i
Property:,/ / . Commercial ! ,
Size i--3 . el Residence (/ No. Bedrooms Z Basement Type ►/+/o oV
l
Water 5upplys Public 1 We ,�) Spring , Other i
Is any water supply or 'body of Prater within bfeet of sewage system? Yes No 4' I,
SKETCH PLANS AS DESIGNAThV ON BACK SIDE OF THIS SHEET. I
f
Septic Tank7A0 gallons. Drainage System Length-2i feet. Trench Width 6
ifteitea'
And/Or other F.H.A.: Yes No. l%--- 1
Check for Installation ofs/
Automatic Laundry ( k'), Automatic Dishwasher ( ), Garbage Grinder ( ).
Is Contractor installing septic tank? Yes No : Drainfield? Yes �No 1
Name and address of Sewage Contractor: -7/a. ( ,0,/ _ ' 7a G 2,
i
THE UNDERSIGNED hereby applies for a permit to construct a new (X) and/or alter (ii .
a sewage system on above property. The construction and specifications are to be !
in accordance with the "Minimum Requirements and Standards Regulating Sanitary
Sewage Disposal in Thurston-Mason Counties." i
Applicantts Signatur ddress._fc, 0 W. ,
e,...ii ..„(i,44.
NOTE: Please refer to nI•;inimum Requiremen s and Standards Regulating Sanitary
Sewage Disposal" and the accompanying drawings.
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Permit No•n 11 Fee $?.SCE gate Issued3- 64By \ p ;`---
Area Sanitarian
Dates Inspected 4 ,vor c o nn p /,T-4 - Remarks
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Date Approved Approved By
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