HomeMy WebLinkAboutBLD2023-01404 - BLD CD Environmental Health Review - 11/20/2023 MASON COUNTY Permit Nosy{1J'I5/g3 _y140 Y
COMMUNITY DEVELOPMENT p z
Permit Assistance Center, Building.Planning
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: D z
NiAME:Samamna haawn NAME:Samanma Naaam 7
MAILING ADDRESS:+e100 E SI.b Retie IN MAILING ADDRESS:141N E State Rwle 106 m
CUY:DMd" STATE:IA'A Z)P:98M CITY:BeOes STATE:WA Z,IP:mm = Z
PHONE#1350 foot 1177 PHONE: CELL:360486•nn
PHONEft2:WO 01<062 EMAI,:Semmykaawnl3®Icloua.ccm --I
EMAIL:.mmy1amam3Dimua.wm L&I REF# EXP.
PRIMARY CONTACT: OWNER 1] CONTRACTOR❑ OTHER❑
NAME----a EMAIL S.dhhd eaeenI3@acaudmm
MAILING ADDRESS 14180 E Slate Rwb IN CITY STATE WA ZIp38826
PHONE CELL aef O
PARCEL INFORMATION: m c n
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PARCEL NUMBER(12 Digit Number) +21gss1-12M8 ZONING m o
LEGALDESCRIPTION(Abbavitted)densonse"stants ah'—'ereueasessan" FIRE DISTRICT T o
SITE ADDRESS 1e3 E Colonels SIT CITYAIIyn O a
DIRECTIONS TO SUE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER TRAN 14%: YES[] NO 0' SNOW LOAD:`a
ISPROPERTYWITION200FTOFIREFOLLOWING: (Caaeku11rMro300.
SALT WATER❑ LAKE❑ RIVER)CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW E) ADDITION 0 ALTERATION❑ REPAIR❑ OTHER
USE OF STRUCTURE(heemese,censer,cs_lalelde ee)Re¢Henee
IS USE: PRIMARY I] SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES anise tMe 0+ YES(Pen(e)a/elegl❑ NO
DESCRIBE WORKB�'ManNacarea name kr primary reaaarce
SQUARE FOOTAGE:tied ea d)
ISTFLOORtd33 aq.ft 2NDFLOOR_sq.ft. 3RDFLOOR sq.R BASEMENTaq.R
DECK_aq.R COVERED DECK_sq.ft. STORAGE q.ft. OTHER_p.ft.
GARAGE 4.R Aherhed❑ Demched❑ CARPORT m,.ft. Attached Detached❑
MANUFACTURED HOME INFORMATION: a4 COPIES OF THE FLOOR PLAN REQUIRED"
MAKEFkeMcaa Hareapeaon MODEL evemodn EV28502E YEAR2023 LSNGYNI&
WIDW21V BEDROOMS BATHS2 SFRIALNUMBER
ENVIRONMENTAL HEALTH:
SEWAGFESEWER SOURCE: SEPUCEj SEWER❑ I NEWD EXISTING
PLUMBING IN STRUCTURE? YES D NO❑ Ijyer,aaaah din glared Waler Ad...Form
PERIMETER)FOUNDATION DRARJS PROPOSED? YES❑ NO, EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2 TOTALBEDROOMS 2
OWNER ackwwlsays Nal autmlaalm INlna¢umte InlallneWn Ircy reaull in a alcp work ortlar a pemul revouWn.AcknoMea9ameril Neucbb by
tiplWYfe ne'au.ICedere Inel Bm nrt owrcrene Ioniser OeGera Nel em entitle"IB mwlw Ni¢permit entl bao Ine vroM e¢h...an raFM
haVesenpmwsredrlmm a91M mroStaryon pnoidesta wanyw and gnats emagNes Mason Count,aoasister pa.a Tna."hawbgl
"rash",repreNnla tat the iMOrtn. T0.p,Ntl '¢cwraraerneg n emplOyeeaa1Meson Countyaccessto a.esnO eeaawi pro ini
ens ewewrels)rot renew aria inapecllon. mle r+ermNaoNicetinn cecwnea nun 8 vole rt won orawronzee conaysanan is riot wmmencea.nlFm+eo
_ a.ya onn caa+mNnn wabauwemea laregnaaN leO aeys.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTNITY OF THIS
PERMIT APPLICATION OF I DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASOM
COUNTY CODE 14.011.42)
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SiOnalursf (Mast Ee slanetl by Me OWNER) Data
D ARTMENTALREVIEW APPROVED DATE DENIED DATE TAGSMOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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EH Setbacks
A.) Drainfield/Reserve requires 10'setback from footing/fo ndations
B.) Septic tank(s)requires 5'setback from all footing/foun tions
5 C.) No foundation/Perimeter Drains within 30ft.downgradi nt of
Drainfield/Reserve area
D.) No Cut Bank(s)(greater than 5fl and over 45 degrees) NithIn
50ft down gradient of Drainfield/Reserve area
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EH APPROVED
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