HomeMy WebLinkAboutWAI2024-00029 - WAI Health Waiver - 4/3/2024 r 0 ON Cotw4 L-JI� 12� L�— C3C70��l1
Public Health
Always mrking for Oferhealtnief Mason County
415 N 6`s Street, Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 v Belfair:(3601275-4467 ext 400 b Elma:(360)482-5269 ext 400
FAX (360)427-7787
Application for Waiver/Appeal
Amount Paid:
Receipt Number:
Instructions
1. Complete Pans I and 2.No determination can be made until these pans are fully completed.
2. Fees may be billed for waivers and appeals,based on the Environmental Health Fee Schedule.
3. Submit completed application with attachments to Mason County Public Health for review.
PART 1. Applicant/Parcel Identification
Name of Applicant Katie Laframbois Telephone g7a30ea09n
Mailing Address of Applicant 20 NE Quail Trail: Belfair, WA 98528
City Belfair State WA Zip_ 98528
12-digit Tax Parcel No. 1 4 1 _1_ " 1 — 3
Site Address 20 NE Quail Trail; Belfair, WA 98528
Subdivision Name and Lot
PART 2: Nature of Waiver/Appeal
❑ Class B Reduction in Vertical Separation ❑ Food Sanitation Requirements
❑ Building Permit Review Policies ❑ Group B Water System Regulations
K7 Location, WAC 246-272A-0210 ❑ Water Adequacy Requirements
❑ Holding Tank WAC 246-272A-0240 ❑ Enforcement Timelines
❑ Mason County Onate Standards ❑ Departmental Determinations
❑ Contractor Certification Requirements ❑ Other
(Installer,Pumper,O&M Specialists)
Description of Waiver/Appeal(include justification,additional material may be attached.):
10'from building foundation down to 3'-foundation is side slope
Mani home with no basement
Very deFem Nne:i coil- Infiltrative area to he naap
Applicant Signature: '�� Date: 04/2/24
J:\EH Fnmti\Waiaer-Appeal Mason County Local Revised 12/l/15
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PART 3: Public Health Evaluation (Staff Use Only)
I. Type of Determination Required: Type of Onsite Waiver(if applicable)
� nn
i I Appeal yl.rvaiver O None required C Class A C Class ll ❑ Class C
2. Identification of Specific Code/Standard/Determination(include date of determination or
latest Code/Standard revision)
3. Nature of Appeal:
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lour FJ fo M &Ki t"SwR"Y-
4. Hearing Official:
❑ Board of Health ❑ Health Officer
❑ Pollution Control hearing Board ❑ Public Health Director
❑ Certified Contractor Review Board Environmental Health Manager
5. Mitigating Factors:
A(w "' la�" t O��'ah.(`i �f rip rlu-�
�.14 AA A
6. 1 have received this waiver/appeal request. It is complete and mitigation required by the state
and local policy has
� IT�W✓t,been subm�"ittted.
t°L.Staff Signature: 1;ew Date: Lft(tm2r
PART 4: Determination of the Hearing Official
The hearing official has determined that approval of this request will not adversely affect public
health and is hereby granted.This decision is based on the following findings and conditions:
❑ The hearing official has determined that approval of this request could potentially adversely effect
public health and is hereby denied. This decision is based on the following findings and
conditions:
Hearing Official Signature: )�/ Date: a t
JdEH Forms\Waiver-Appeal Mason County Local Revised 12/1115
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