HomeMy WebLinkAboutWAI2023-00113 - WAI Health Waiver - 11/17/2023 415 N 6TH S
MASON COUNTY SHELTON
EXT400
SH S N TRE . ,SHHEL TONON, A9858a
BELFAIR. 360-275-4467, EXT400
Public Health & Human Services ELMA 360-4e2-5269,EXT400
FAX 360-427-7787
DENNIS DALE
4425 HARBOR COUNTY DR APT K71
GIG HARBOR, WA 98335
Applicant. DENNIS DALE
Parcel Owner: DENNIS DALE
Site Address: 81 NE Marine View Dr
Primary Parcel Number. 322245202904
Waiver Request Number. WAI2023-00113
Waiver Description: Onsite: Location,WAC246-272A-0210
Waiver Submitted Date: 11/17/2023
Waiver Review Date: 11/20/2023
Waiver Status: Approved
If you have questions or concerns let us know.
Sincerely
David derson
360-427-9670 Ext.353
d a n d e rs o n@ m a s o n c o u n tywa.g c v
[Roza
' ' MASON COUNTY Rec 2 u 2023
h . COMMUNITY SERVIC elvEn
Building,Planning,Environmental Health.Community Health
415 N 6th Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 C. Belfair: (360)275-4467 ext 400 C. Elma: (360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid: If
Receipt Number: 2023- 0 I I 3
Instructions
1. Complete Parts 1 and 2. No-determination can be made until these parts are fully completed.
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 entification 3 L
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Name of Applicant (t,Telephopp
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Site Address / NE din At ME VIEW / c • - lc//t�/ 6-4 ti
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Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Contractor Certification Requirements
❑ gass B Reduction in Vertical (Installer, Pumper. O&M Specialists)
fY Separation /A 6,R, 2 "A' r A C 0 Food Sanitation Requirements
❑ Building Permit Review Policies 0 Group B Water System Regulations
❑ Location,WAC 246-272A-0210 0 Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 0 Enforcement Timelines
❑ Mason County Onsite Standards 0 Departmental Determinations
❑ Other
Description of Waiver/Appeal (include justification, additional material may be attached.):
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Applicant Signature: /� „ � Date: ((I IA'1 t'l 73
1\EH Forms\Waiver-Appeal Mason County Local Revised 1/20/2017
Page 1 of 2
PART 3: Public Health Evaluation (Staff Use Only) 1 0 Ca I
. Type of Determination Required: Type of Onsite Waiver(if applicable)
E.Appeal Waiver - None required E Class A r Class B E Class C
2. Identification of Specific Code/Standard/ Determination (include date of determination or latest Code/
Standard revision)
3. Nature of Ape al:
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4. Hearing Official:
❑ Board of Health 0 Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board it Environmental Health Manager
5. Mitigating Factors.
B Veld raj 'COMAifei. it t'p radlel !From -IN2 5-17k 1k.
6. I have received this waiver/appeal request. It is complete and mitigation required by the state and
local policy has been submitted. 'Jc�7
Staff Signature: /f' Date: ! / /7W U3
PART 4: Determination of the Hearing Official
0—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: Date: t ° ! ZO 4 GC/?3
1:\EH Forms Waiver-Appeal Mason County Local Revised 1/20/2017
Page 2 of 2
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