HomeMy WebLinkAboutBLD2013-00623 - BLD CD Environmental Health Review - 7/25/2013 (2) tOMMUNfTY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Official use only
415 N.6th Street Permit Number: 36 la2013• t7aOa+Z3
PO Box 1666
Shelton,WA 98554 Date Received: 7-7-5- 13
Shelton: (360)427-9670, E)d 400 Amount Received DO
Beltair. (360)275-4467 Ext. 400
Elma:(360)482-5269 Ext.400 Receipt Number Ill f
Fax (360)427-7787-
Applic t Information Type of Review,Wt4on
Applicant Date -26-I Building Permit fer4
gAddress .O.�X 7gf3 17 New3RaplO Commercial Buildin (i 2013
sty
ate Zip 0 New 0 Repla[ Vceement
�.O(o• `f�-i9 • �0O 0 Building/Commerciat•Pertnik+ -A--40ls
uaytime Phone Other Phone -
O Tenant Review
E-Mail Address 0 Pre-Application
Parcel Information
12-Digit Parcel Number
Site Address IP4-i11,P uE Uniay) WA `-t'?)51il,
Streat Number Street Name City
Type of Job Please submit a scaled plot plan
Describe work 4qoor&� showing all existing and proposed
building, on-site sewage system,
Number of Bedrooms 1 Q _ and well.
On-Site Sewage Information Water System Information
u
R On-Site Septic System ❑ New *xisting Plumbing in structure? )111�11es 0 No
0 Sewer Name of Sewer System If yes:
Using an existing on-site septic system will require a current Please submit a completed Water
maintenance report and a Record Drawing(Asbuilt). Documents Adequacy Form.
for both of these requirements may be on file with Mason
County Public Health. Other requirements may apply.
A7jr Sig u
Date 7-Z!5—I 75
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sawage System &V rl0 r 7iU
Tenant Review
Revision
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