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MASON COUNTY
SHORELINE PRE—INSPECTION APPLICATION
PLEASE PRINT $44.00 Fee Required
1 . Owner: Applicant: AC K
Site Address: Applicant Address: l
Owner Address: City: i
City: St Zip Phone:
Phone: ( 1 2. Parcel No. - -
Legal Description:
3. Purpose of Pre-Inspection: as
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4. Use of Building:
5. Is there any type of water on or adjacent to property?: saltwater lake
river pond wetland seasonal runoff other
stream seasonal creek
Directions to Site:
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.
Applicant Signature: �. 1" �-�-�' `-�' Date: `
Return application to: Department of Community Development,Planning Division
P.O. Box 578
Shelton, WA 98584
(360) 427-9670/1-800-562-5628
Please include a $44.00 check or money order payable to Mason County Treasurer
FOR OFFICE USE ONLY: Accepted by: __ Date: ___
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Departmental Review
(For Office Use Only)
Planning Department Findings:
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