HomeMy WebLinkAboutBLD2023-01153 - BLD CD Environmental Health Review - 9/26/2023 slIII
e 'un:. MASON COUNTY COMMUNITY SERVICES Permit No:bLQ (/O 3 UL� ��
PERMIT ASSISTANCE CENTER: E C E I\ /E D
f � . .�i$ •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSH AP L C �/ L
fi„f;' ;0 615 W.Alder Street,Shelton,WA 98584
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f . Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ENVIRONMENTAL
' *��y Bellair(360)2754467•Phone Elma:(360)482-5269 SEP 2 6 2023
pb 'u HEALTH
BUILDING PERMIT APPCt�A� lO(��� _„-
PROPERTY OWNER INFORMATION: CONTRACTORC I INFORMATION:
NAME:G/B".. M- S�o//nieyet— NAME: i�1 c I)0. /�€ J /
MAILING AIQDR.gSS:c9 0 Pow e// IQ o ca MAILING ADD�SS:/7/ SE f 0.u/c yn L
CITYca."-fie roCi< STATE:W, ZIP:9R6/1 CITY: She/toy, STATE:WA ZIP: 9353 y
PHONE#I:(36 o) 36 Z- 53 3$ PHONE: CELL'L360) 4.0 - oil-7
PHONE#2: EMAIL• i
EMAIL: S o t1 S re)ck.s ,C o frl L&I REG# IG At_WT77 D EX• /LL42Pa(.( ,-D
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER D n N
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NAME EMAIL rn
MAILING ADDRESS CITY STATE ZIP N
PHONE CELL rn O
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PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 226/8 -52- °0'3 7- -
,/ ZONING
LEGAL DESCRIPTION(Abby viated)%t.",be r/AKC T 44 LoT" 3 Z FIRE DISTRICT
SITE ADDRESS /5/ t. M c La e 7)r. CITY She '/-a
DIRECTII�gqNNS TO SITE ADDRESS e 71e 7 - e r tlo''. 2 a. NM - o n o
Herron .)r , f er, r,:g1,-4 snAo E./vie/Ale 'r.,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO[SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply).
0 SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW Eff ADDITION 0 ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE( sidence,Garage,Commercial Bldg.Etc.) r eS/a1 E''Ice-
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS l NUMBER OF BATHROOMS,
HEATED STRUCTURE? YES(Whole Bldg)L7 YES(Parr(s)ofBldg)❑ NO 0
DESCRIBE WORK
SQUARE FOOTAGE: (proposed)
6T 1ST FLOOR 0 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 0 Detached D
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: 1\ ' w r'` d-c-- e
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES (1 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 4 TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop{{work order or permit revocation.Acknowledgembnt 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 permitiapplication 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 Z� , J/Z ---- A 4 - /6 i Z 2 3
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANK NG DEPARTMENT
FIRE MARSHAL ,�n`f--
PUBLIC HEALTH ' 1 jct('Z3 4 u)- 5 04a4
.. SiiLee P/an for /_/ �. McLane Dr. — 6/e, Sao/%ever'
Parcel /V,,,,, er: z2.0/ $.52, - ObO32 S-41e_ ///= /0/
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r,ree„4 e l+ 14or#11,
EH Setbacks
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A.) Drainfield/Reserve requires 10'setback from footing/foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations
C.)No foundation/Perimeter Drains within 30ft.downgradient of
Drainfield/Reserve area EH APPROVED
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
— 50ft,down gradient of Drainfield/Reserve area Rhonda Thompson 12 04/2023
No perimeter or foundation drains within 30ft of drainfield
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