HomeMy WebLinkAboutBLD2024-00333 - BLD CD Environmental Health Review - 3/12/2024 Permit ND: iQ.GV�' 'W5
MASON COUNTY REcuv
COMMUNITY DEVELOPMENT
vermXAazUbNke CmM,BmMInO,Plankbe MAR 12 2024
BUILDING PERMIT APPLICATION t
PROPERTY OWNER INFORMATION: U0..il ONTRACTOR A`FORMATION: m
NAME ( e 1 NANMIC--
crry:: 6ADDRESS: MAII.IN� —
IND Kam(+.L SAE: CUY' m C)
PHO ql:- — PHON CELL. m O
PHONE 82 EMAIL D z
EMAIL: ` LAI A /
P YCONTA OWNER CONTRACTOR OTHER❑ m
NAILINGA 1• •• -_ nJ OW MAI
2
m
PHONEGAD ESS CELL OTY SfATE_ZIP_
PARCEL INFORMATION:
PARCELNUMBER(12Di9it Number) c5l9ol -50-o10 'I ZONING
LEGAL DESCRIPTION(Abbnman A) FIRE DISTRICT
SITE ADDRESsa • {.LYE-�-�a tID1�R�--CITV��" �Ti-e_— — `?y
DIRECTIONS TO SITE ADDRESS j
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M THE PROTECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YEe NOD MOW IA)AD:_prf Q
ISPROPERTYWFFRIN200FT%TBEFOLIAWDIG: (a olNwygp:
SALTWATER❑ LAKE RIVER/CEEEKD POND❑ WETLAND❑ SEASONALRUNOFF❑ STREAM❑
_ TYPE OF WORK: NEWp, ADDITION ALTERATION0 REPAUt0 OTHER El
USE OF STRUCTURE(.e —,taro•.0 ae ial Ed,Fm)
IS USE:. PRIMARY[I SEASONAL NUMBER OF BEDROOMS NUMBEROPRATHROOMS I.5
HEATEDSTRUCTURE? YESM`W.e_AWEr YES(Pen(TdBhWIl NOD
DESCRIBE WOAK VP/, - SFC.
SOUARE FOOTAGE:I ,,000
1ST FLOOR,'1+1—W.ft 2ND FLOOR sq.ft 3RD FLOOR_p.ft BASEMEN_W.R.
DECK_p.ft COVEREDDECK__K.R. STORAGE aq.0. OTHER_sq.ft
GARAGE_,ft. Aaarhed D D&admd[I CARPORT p.It Al.W[3 Dmdoof o
FACTURED HOME N: a4 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL LENGTH
BEDROOMS BA7HS SFRIALNUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWFRSOURCE: SEPTIC SEWER NEW EXISTDNGW
PLUMBING IN STRUC ? YESp NOD 1/yes,oddch ronyleeM WawAde uaty Form
PER@IBTER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING EQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
DINNER acMnWetlpaa NalauGnblm W bNassvNeNa bloNmalion mry mJlln a slop woM orEx or punlll lavamlbn.MhnWeE9emenlN nW k ty
6ipnelWe Eelvv.l a9dert PY 19Ni tlro wmer Yal l NMwOxlere Met em en11tlM W recaNe Ilik pBiTtl eM b EO NB xwk m pvpwal'_ Eew
opWmE pamlbslnhwn eII1M rxmurypvpw.InGMln9 airy amemaM1MEerw ImrOw al iMenel NepeNWg Nk ggwt Tlw amnr m bpal
mprteemaYy,rapBaaNy ylaltlm MumNpn poNCeE'a accuale aNN pNa^Nz empblvee N Mezon Lwnryxcas to Me eecve axnoe4 pmpMY
Yq eNxBirelal M nWBweM Inepectlon Thh PoaaNappliu0on Cecwnee nuA 6 roq M vM a BaTs¢etl wrnaWWctioa b McommenmC wXNn tm
Gyf aManeEuclbnwNk b euagMW Me peME N 188 tleya.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF ISO DAYS OF MORE VALL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.IBA3)
Mtre0 uaWs nod ke OWNE )AL RE "MOVED DATE DENIED DATE . TAGSNI SICONDTTIONS
PARTMENTPARTMENTLTH
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EH SETBACKS �Id2by�1
N ominfiela/deserve requires 10'setback from fwting/foondaamms
0)Septic tsnk(s)requires 5'utback from all foot, ndetions
EHA—PPROVED Oeof anda[iorJfaeHanlondrains within 30'down-gradient of dmi�el
re
mimeaa 01 Nocona),Banos)(greater than S'&over d5 degrees)within 50'
down-grad'wm of drainfield/reserve area