HomeMy WebLinkAboutSPI2006-00037 Short Plat Copy - SPI Application - 2/4/2005 MASON COUNTY
PLANNING DEPT. PRE-INSPECTION APPLICATION
PLEASE PRINT {{�/ r
$205.00 Fee Requi
1. Owner: Applicant: 1 t ro �f- ��aa�rq �r 011,4-4
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Site Address: ., Applirapt Mdress:_ 1 o 30 o
Owner Address:_ i 3+ F���l l m w— rc ct G City � -e-y t,�2 Steil -zip
City: St c, Zip I? Phone:_ o(n b day
Phone: N Ato --70 q�Z day Phone:_(�2 g� S� - 30 5 7 evening
2. Parcel No. I I a 02- _ _lil __
Parcel Ner- l 21 a g 23�_ _ l o Z 3- Email Address: wand tea , e Go Mcas L. n4
�►019-2-3°I tb 2 v ^�1 �Le al De ri tion: GPM oe.. -
9 P Planner: ht ,�. .� t
SMP T omp. PlaqeiA h&&I Type of Use
Water Body "1 X 1 ► n" v2alzf v
3. Purpose of Pre-Inspection : o b-G ct-b n_J__U+66_c"
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4. Use of Building: pec�e-y" �
5. Do any of the following exist on or adjacent to property?: slope( ) saltwater lake( river
pond ( wetland ( seasonal runoff( other( stream ( seasonal creek
Directions to Site: U t.Pc,c.) L'on 2pc� }�
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If the information is incomplete, then Mason County must disclaim any errors resulting from deficiencies in the
original application. Pre-inspection reports remain valid only until development changes occur in the vicinity which
affect the lot evaluated in this inspection, or the laws regulating development of the site change after the time of
inspection.
Applicant Signature: Date: 2- G s`�
if you would like to be on site during inspection, please check here:
Retum application to: Department of Community Development, Planning Division
P.O. Box 279
Shelton, WA 98584
(360)427-9670 A EZ E I V E D
Please include a$205.00 check or money order payable to Mason County Treasurer FEB 0 4 2005
When completed, this form becomes part of the panel file.
FOR OFFICE USE ONLY:Accepted by: Date
Please illustrate below the proposed building site in relation to water&property lines: U - NING
�� MORE ON BACK SIDE
Please illustrate below the proposed building site in relation to water and property lines:
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Departmental Review
(For Office Use Only)
Planning Department Findings:
Revised 12-26-2003 SRG
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94-215V
TILE PROPOSED LOCATION OF HELLS A
M' RADIUS ARE ADVISORY ONLY. HOLMAN d A 880 CIA TES
MELM TE APPLICATION AND SEPTIC PROFESSICNAL LAND SURVEYORS
S I TV I NSPECT IONS M T BE APPL I ED t 807 W. RAI LROAP, SHEL TON. WA.
FOR_PRIGV TO_90ILDI1Mo PEMIT. (zas)426-2990 #&"4