HomeMy WebLinkAboutBL;D2023-01482 - BLD CD Environmental Health Review - 12/13/2023 MASON COUNTY Permit Nan1 001OM•n17U
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning OFC 13
BUILDING PERMIT APPLICATION Aki
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: FQ
NAME: 0.e VGr , +CddtS L NAME: . e C 'Q:
].1 MAR.MG ADDRESBn+i Mrra—RZP�e..�.R LMD.ING ADDRESS:
V CTT CV:f_+a STATE:W ti ZIP: RfSML CITY: T ZIP:_
G PHONE#1:�/ - PHONE: CELL:
/l PHONE#2: Sow - ( 4 A EMAIL:
✓� EMAIL. L&.I REG# EXP._/_/_ m
+ PRIMARY CO TACT: owNER❑ wNTRAcroR❑ orxeR❑ z
NAME—
MAILING ADnmS P CITYIL STATE ZIP_ _ �
3 PHONE CELL m O
v PARCEL INFORMATION: > z
PARCEL NUMBER(12 Digit Number)O`LAI V 4 — la `1 Ilid TONING
LEGAL DESCRIPTION(Abbreyidbal) S y — T 1 I — Q a FOUR DISTRICT = m
I_ SITE ADDRESS CITY z
1 DIRECTIONS TO SITE ADDRESS F Slt\<2f K y 1J Id
QISTHEPROJECFWEI'HINMnOFSIAJPE(S)GREATERTHAN14%: YES[] NO;, SNOWLOAD:_paI r
'r ISPROPERTYWDMM200FTOFTHEFOLLOWING: (Ceutmlam�ytyl�
SALTWATER❑ LAKE❑ RIVER/ TU ❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF W ORK: NEW ADDITION[] ALTERATION❑ REPAIR❑ OTHER ❑
�� USE OF STRUCNRB(h+uxa.cwasc Cu..w/uex tc./ R,eS-o�crt.L.
SUSE: PRIMARY❑ SEASONAL❑ ,.,/NUMSEROFBEDROOMS_� �
_NUMBEROFBATHROOMS
TED STRUCTURE? YES RPIa'e e4y110 YES fvaN+)�exW❑ YN.O❑
6 ESCRIBE WORK'T.-1-T?A\\ s..� Mw. r
1 REFOOTA : pmP .l U Incluclf9 ('oP/n1CL D2�
ST FL j j O'J q.D. 2ND FLOOR sq.ft. 3RD FLOOR_sq.ft RMEMENT ad,ft }I
DECK _ _sq.tt COVERED DECK, _sq.ft. STORAGE sq.ft OTRER_sq.B. `
GARAGE_sq.It Aouhed❑ Demehed❑ CARPORT _sq.B. Ardis l] Derached
MANIJFACTURED HOME IINFORMATIOM "COP S OF THE FLOOR PLAN REQUIRED' O
MAKE mi�Il.i7n..fleaK MODEI�g.��Fn�in,nQ' ZOZi LENGTH SIR
WIDTH_ 14 BEDROOMS— BATHS o-L SERIAL HUMSER] ♦A
ENVIRONMENTAL HEALTH: �/
SEWAGESEWERSOURCE: SEPTIC17 SEWER[] Ur I NEW EXISTING❑
PLUMBING INSTRUCTURE? YES jr9 NO❑ #',s,aiddi wle NWacerAdegmry Form
PERIMETEBROUNDATION DRAINS PROPOSED? YES❑ NOP MISTING SQ.FT.
EXISTING BEDROOMS PROPOSEDSEDROOMS_CA TOTALSEDROOMS�
GNHFR OMwNaglOs tlW suhnisLm dlnOdv210 Nlmrulun mry nW in 0 elcp vM oeMta pemNnwuticn.Mknmtle]i0menlMrh-IB Ey
Bgnalurt bbw.l EetlOrt Mel em M wni0r OM IUMxUx1021M m MWeE b IxslwlM1ii pOrmil mU b EOMenvM U prt-paetl. M1ee
oMmNp5,repunhum CANeed,hr pet IntldNnpeeryOwm1M Iw- pr petlix d Inbreaurry nno pmlea TM1eowner mlapel
2pesmdure(a rt r summe Mel IM iechon 4pn penNEeuip•sole Ond neems aJs wid Vs al MOsm Lwnry whose b Pe atom tlexnree p hrr i
wM sorR don0)brreNew antl inepsurnoW for
enod of ifurdays.Ewmmea null8 wit HxoM or auNdelzeE mnsWctipn Is nM wmmence0 vnMln 1M
Ery6 or II Wn9eucAm vNM z suapxpuE lM a peeipE N I00 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 1E0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.01
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Bgnelure plOWNE MusI Ee BMnatlMNe OWNERI Oeb'
DEPARTMENI'ALREVIEW APPROVED DATE DENIED DATE TACSINOTESICON HTIONS
BUILDING DEPARTMENT
PLANNPIG DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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EXISTING 3BEDROOM ����:V�J
PRIMARY& RESERVE
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(SWG99-0172) BFVSO
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EXISTING SEPTIC TANK J ' JL
EXISTING 3 BEDROOM HOME P ill
EXISTING WELL I ' I
O� (2-PARTY) j
I WATERLINE j I
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PROPOSED 2 BEDROOM PROPOSED
5EPTICTANK I
I PRIMARY& RESERVE
5' rnin
044 SA27
new A�m ru4r/
F? -Act(L bL� nL j
� Y' FUTURE
E . APPRC; EDPROPOSED
OOMADU bE
TRACKS CARPORT
A)Drainhel /Reserverequires l0'setback from footing/bundations —
5)Septic to CseWacLLemaYJoodagYaueOaYaer� — — — — — ��
q No fooMatioMpedmeter drains within 30-down gradient of drainfald I
reserve area
D)No cut(s),bank(s)(greater than 5'&over 45 degrees)within 50 0'ACCE55/LMLITY EASEMENT
—�—
down radient of drainfeld/reserve area JJ,, JJ��
BE CXARGEO AT TIME OF INSTA4ATION 3ld�JT(�TT/'U 11492
LDISICNF
ER: ROBERT H PAYSSE kTBITLE I: TEST HOLE 2 TEST HOLE 3:
TAT �p ��n�7/� T��/� S D6t1(L16 0a)il LPIONEER. DIGGN( , NC- k.2210 9 129 0101 60 IILVIS 6O lkwls a,
SEPTIC DESIGNS S: )=MASONBENONRD
3lW3EMASJNBEN`,:OhIRD. GRAI'EVIEW,WA 9d596R: ROBERTH PAYSSEwa°rm"r...a'��is°� 'a
Oma 3604261303 FAX-36(4212353 IfEPLAN SCALE P=50'
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