HomeMy WebLinkAboutBLD2023-01198 - BLD CD Environmental Health Review - 10/31/2023 ENVIRON:',,�ENT Lrmtt No:bLORO a3 -
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BUILDING PERMIT APPLICATION OCT 3 ] 2023
PROPERTY OWNER INFORMATION: CONTRACTOR T FORMATION:
' a 1, �` NAME: ca3C2>AV\it..>%."-‘ �� RECEIVED
NAME: � �MAILIN A RESS: 4-5 lcy;� ' MAILINGDRESS:
CITY: 0 q'— STATE ZIP:C!IL CITY: STATE: ZIP:
PHONE#1: — J\10 C12.0 PHONE: CELL:
PHONE#2: • EMAIL:
EMAIL: C...`LS ci Y _Q ot,• L&I REG# EXP._/ / .\
PRIM Y CONTACT: OWNER❑ CONTRACTOR OTHER❑
NAME ' V EMAIL C.AJ J r
MAILING ADDRESS r %Y CITY �t S ATEUV r, ZIP littC
PHONE CELL
PARCEL INFORMATION: /,� �)
PARCEL NUMBER(12 Digit Number) \21 V�'�Z I0 t/ ZONING
LEGAL DESCRIPTI N(Abbreviated) ,n FIRE DISTRICTt1
SITE ADDRESS 4-X7 £. r `C t4".e cove._ 9V . CITY G'rpW!a[ J
DIRECTIONS TO SITE ADDRESS
IS TIIE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO ENSNOW LOAD: psi
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW g ADDITION❑ ALT RATIQN 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) \ )�., \\eY
IS USE: PRIMARY. SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS 2,
HEATED STRUCTURE? `YES(Whole Bldg) ES(PanIs ofBld)0 NO❑
`
DESCRIBE WORK ,J' LJ -,,$ C!L c \ V, —L
SQUARE FOOTAGE: (proposed)
1ST FLOOR ial°f,.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.
GARAGES3 4 sq.ft. Attached i► Detached❑ CARPORT 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 SEWER 0 / NEV)* EXISTING❑
PLUMBING IN STRUCTURE? YEScel. NO❑ if yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES®, NOV EXISTING SQ.FT.
EXISTING BEDROOMS ID PROPOSED BEDROOMS 3. TOTAL BEDROOMS 3 v
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
1 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 perrnit/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 —� x'� 3, W L,3
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH '• ,t ' \211 17i-S Nk:Y\
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SIDE �� / —
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SIDE
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RR5 Zoning
Front Yard Setback. 25'.
Side& Rear Yard Setbacks. Residential dwelling
and accessory structures is 20'.
OR 10%width of lot if not more than 100'wide
OR approved ADV
APPROVED
MASON COUNTY DCD PLANNING t f
SCOTT RUEDYAtCP
11/07/2023 `l \ j
\\\
signe\ sm.'w.a
by Scoff Sq,,,
Ruedy "i"e
\ The destr-u- rc -oc.alteration of Fish and Wildlife Habitat
Conservation Area's ortheiquffers through removal,excavation,
grading,dumping.discharging or fill' ff any material;clearing;
shading;intentional burning;vegetation rePlovat(terrestrial,
freshwater.or marine):planting of non-native vegetalibTTlhat
would alter the character of the FWHCA or buffer;or the
{ construction or placement of structures or increasing the
/ <-, structural footprint shall undergo mitigation sequencing and shall
b0 I ssi- require a habitat management plan. `
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()L.199\03— 01 I 98
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EH Setbacks
A.) Drainfield/Reserve requires 10'setback from footing/foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations
EH APPROVED C.)No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
Rhonda Thompson 12/01/2023 D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50f1,down gradient of Drainfield/Reserve area