HomeMy WebLinkAboutBLD2023-01390 - BLD CD Environmental Health Review - 11/20/2023 MASON COUNTY R.rt4 3 -e1370
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning NIJV 15 2U23
BUILDING PER ITAPPLICAAIT W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: `"FDA NAW:
MA ENTAL
ILING ,DRESS: MAI
LING ADDRESS:
CITY: STATE: .ZIP CITY: STATE: ZIP: 1J
PHONE 01: 60— 3 '8009 PHONE: CELL: F:: T�'{
PHONE 02: EMAIL:
EMAILj14Rt 8ouxstlL&I REGq EXP.
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILINGADDRESS CITY STATE_ZIP
PHONE CELL ZO
PARCEL INFORMATION: N
PARCEL NUMBER(12 Digit Nluabb)'42104SS00u0�L6S ZONDIG m
LEGAL DESCRIPTION(Abbrroadd�IdBlb'.1( Gda Rs TK 65' FIRE DISTRICT m O
SITEADDRESS ITCE SIA&Myx LA CITY Unl C tO=
DIRECTIONSTO SITE ADDRESS Fraw.S� +Y F e„ E FAcRt.N�_igwg! Nn:0V1 Turn FaCYO
tv, 6 'AAL IIN%01 T c l[Le D c I Ito 's 0.,�hF
IS THE PROJECT WITRIN 300 FT OF SLOPE(S)GREATER THAN I<%: YES ff NO(] SNOW LOAD:�s!
ISPROPERTYWITHINSOSFTOFTBEFOLLOVBG: Flnamlmei epny/:
SALTWATER❑ LAKES RIVERICREEK❑ POND❑ WETLAND❑ SEASONALRUNO"D STREAM❑
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USEOF STRUCTURE(nrreeww,GE"csnwammalk tx) p,Lgi�M.(C
ISUSE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS 3_ NUI.IBEROFBATHROOMS U5-
HEATED STRUCT UREV N NO❑
DESCRIBE WORK SQUARE FOOTAGE,0,,,y,o..e/
I ST FLOORv02�I & DID FLOOR ��ag sq.0. JRD FLOOR_p.A BASEbRa1JT_sq.ft
DECK m,ftL COVEREDDECKKI q.fl. STORAGE '.R. OTHER s4R
AG GAREST ,R A// MM14 Desached❑ CARPORT K R. Aemched❑ DesseodfD
MANUFACTURED ROME INFORMATION: ed COPIES OF THE FLOOR PLAN REQUIRED•
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERW,NUMBER
ENVIRONMENTAL HEALTH,
SEWAGESEWER SOURCE: SEPTIC$ SEWFA❑ / NEWW EMSTMG❑
PLUMBINGMSTRUCUREI YFSA NOD Ifye eachgmple/ed Waser Adegmcy Form
PERRAETERAOUNDATIOND INS PROPOSED' YES19 NOD EXISTING SQ,FT.
EXISTING BEDROOMS PROPOSEDSEDROOMS cs TOTAL BEDROOMS
OWHEA edmMMpas IM[ubnWbn q ira0.Vele IMo,melion may nauX in a pap wlk wMwpmml revocallon MhnW edgemeMNeuN la Ey
pgN1w0 wba.IdeMre NMI I un Illavineren°I MMe�E�a�e WI I am eMlllad b le¢IW IX9IRlrnll anE to Oo Rn wnh es p'aposW.l IWa
dossunpnmisabnemm all Ma a summon WNea ow islnq any a and ga n m so°Mlu of son Ct lepmding Nls pmia s Tie avrmwbgp
IepleFenlB°ve��gNe5era6 mp Ina Inbrtnallon pmvl0e01a ew,nle and q�enb emgayees M Meson Cwnly Yfesb IO Na aWw tleem[a]pgplly
eM a4ud npl lss nspatll lapar on Eewmunu116ap0 ilwoM OlvulMuae mnsWtLoms vY,vnmwa°wllNnt�
dqs orXralsln,Nan waM udsuSpeMed to a penal.l.r 1B0 o days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
�.r /n � COUNTY CODE 14.08.R)
x !/WL� '1 , ll116Iz013
Slgnalme M OWNER(��elWei°sro0 bvthe OWNERI DMe
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSMOlES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIREMARSHAL
PUBLIC HEALTH 2 CfA�
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