HomeMy WebLinkAboutBLD2023-00500 - BLD CD Environmental Health Review - 6/27/2023 IiI.mr
;„,,,,, MASON COUNTY Permit No: 0 L.:9(J( c)a-S -Ob50c)
COMMUNITY DEVELOPMEN' C E I V E D
Permit Assistance Center, Building,Planning MAY - 4 2023
BUILDING PERMIT APPLICATION i1W AJ,ie reet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Warr f S £h d btt le 1ep n-u rn--nu) NAME: ,a i i • t o ._ . • •• .&'. l,_ A i IX) z
MAILING ADDRESS: tx se,s MAILING ADDRESS: 'O61% S III r .
CITY:�k,XT.� STATE:Or ZIP:°1 rerd CITY: .• STATE: W ZIP" . IJ VTI 2
PHONE#1: 2Cro '22�1 6\1-1 leA PHONE: 2tij 7C SILL: 2S 3 S Ny 391 rn O�
PHONE#2: 'Is 3 S 14 '((O��1l5 YY�(7, EMAIL:Y YPf,L �a C` YYt%YI.ce—-m N
• EMAIL: Y�Y2G.11 S1-C-ICJL VY1.111n.r-Corll L&i REG#1-10rite.SIW-11 1In_ EXP.3 Pi /1 j w Aill
PRIMARY CONTACT: OWNER K CONTRACTOR❑ OTHER
NAME EMAIL 1� Yy+r_►{ /_SC`� /�.I�rYTh I .
MAILING ADDRESS CITY STATE W14 ZIP ; _ z m Q
PHONE CELL rj} IS Y
PARCEL INFORMATION: rr'4
PARCEL NUMBER(I2 Digit Number) 22 3-3(Q - 5L -O bb Les ZONING = m
LEGAL DESCRIPTION(Abbreviated) ne h0.10.L 4 L T . b 5 FIRE DISTRICT Z
SITE ADDRESS' O IV._ 4- CITY C
DIRE T1ONS TO 1TE ADDRESS l TZ C/Y1 ern +o D
tin le-ii-HA t .t.f' //ct.d ri tQ ( .prd at, eu.l Ci-e_(la t'-
TS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 4( SNOW LOAD:_psf
TS PROPERTY WITHIN 200 FT OF TILE FOLLOWING: (Check all thus apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ' ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
i USE OF STRUCTURE(Residence.Gwuge.Commercial Bldg.Etc.
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Partfs)of Bldg)❑ NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
1ST FLOOR 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❑ Detached(] CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Cl-eiL.41,0efd MODEL ,I9reP h 20 j 4-2) YEAR 2o2 3 LENGTH 5',[...
WIDTH Gat Li t I BEDROOMS 3 BATHS 2— SERIAL NUMBER
ENVIRONMENTAL HEALTH:
‘ SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW<- EXISTING❑
PLUMBING IN STRUCTURE? YESIr NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NON EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 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 tho 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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
1 ' , / , 5131 3
Signal re of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL '/ /f
PUBLIC HEALTH 1/f ,F[ �f�bC 5 CGry,4 on GGIi"chit
QLQ 2O -DO 60 0
PIQ-+- P( ar� &`rest Halt
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R7 Prabo . y 1NC .` : God' - ,,w... `""`' '°- NI
Pali„t# 2Z33 -_,_ opo_(o5_ 2}45 :_,Zt,,..cy ,y..i, -A.---d
50 NE ` vv.c v F-
C3) 3l x5o P(; y
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LO i 5 s e. 30
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• e:� EXPIR S0 ..';: st` b 0. styX°' WO �/EXPIRES e�r I�1 -TJA_
APPROVED X >_ '" -,e'� i
MAR 2 1 2023 L" \P' � `�..
5'se 5r
MASON COUNTY ENVIRONMENTAL HEAL.' \ o ,....
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12°1„ 5\°S'
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RS.g8'
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OCleanout
O 1,200 Gallon Septic Tank
EH SETBACKS 2-Compartment with Effluent Filter
A)Drainfield/Reserve requires 10'setback from footing/foundations
B)Septic tank(s)requires 5'setback from all footing/foundations ED D-Box with speed-levelers
C)No foundation/perimeter drains within 30'down-gradient of drainfield/ and cover to surface •
reserve area
D)No cut(s),bank(s)(greater than 5'&over 45 degrees)within 50'
down-gradient of drainfield/reserve area
EH APPROVED
o.Anderson 08/08/2023
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