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HomeMy WebLinkAboutBLD CD Environmental Health Review MASON COUNTY PUBLIC HEALTH OFFICIAL USE ONLY oue,aaiwa COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW 415 N.6th Stmet,Shelton,WA W584 (360)422-9670,Exc400 (3(0)275-446],Ext.400 1.Appllcam/ProPerry Information o4 R9oo/1GRu Buur 2 M1 -5n 38 " `"P1oz3 `"` ft� �AA)6' BB&n�2IdN a/ Q�3lz akeabati7 oy me xxvq— S� PCl f Q�GF/+tR L ,m t re.;Tc Sox) ].Type cif Review/Job J.Job/Site Information clw,x atl xwanx, ❑ Residential ❑ Commercial ❑Tennant Review 14 New ❑ Replacement ❑ Pre-Application + .b1lw.nx Taeixaowm 4aan9NunLa naGmel ❑ Remodel ❑ Addition ❑Other(explain below) ewmoms eaoew= cesm vmF uzm,mamaaamro"cwwgawnunis E STofLRroE Z + _ FaNn91V i[ VmWna59.it LW Sq.Ft atlemeMllyeawrol icW NunLV Mnwxa M.1o,eamodeh neetl w amcM1 an Fxls W g Flow%an aM Pmpoud Flaw Plan with room desi9mtioin Max Palx,xtt ttxll. PmPenyo"slwwewlsewnw �� 4.0n-Sid Sewage System/Sewerlrlfi)-01ontj Pe„mex,p„a,PmpmMr�yxew"e 0 v„Pw�vs<waen NumMr"IEmpbyeealXapplkadtl ❑ On-Site Septic System El New ❑ Existing ❑ Sewer Connection ❑ New ❑ Existing S.Water Source lldomortion,�/ Nn,nINO waPWmmu � Plumbing in structure? NAYes El No e;5e T be wmamsaw.snnmirtapplkctl If yes: Please submit a completed Water Adequacy Form. using an exining m-sue septic system.01 requirea cumntmaimenance ioPon An incomplete submitted Water Adequacy Form may be andaxecad Drawing(Asbuilt).nocummuforbom oftheserequo-ementsmay returned,and hold up review process. beon file wiM Mason County Public Health.othw requirements may apply. d.SRe Plan A scaled Site Plan is required with all permits,except interior remodels An incomplete submitted site plan may be retumed,and hold up review process. Paper size /rh Lte plan can be B.SxI1,i5yt6,or 11x17(Max). p�aygeuse checklist babw��� ,�/ f3 []Reserve Drainfield area Existin / rrooposed wells ❑Waterli es Vrope4rtJyJR.,nes/dimonsions ❑Primary urairfield area ❑ r P P ❑ nts SeptitTa(nj'si Vatican ❑Location of<uttainfctu,emeter drains �Ra1 f5lope ©weways/gWorth Arm/Easemeale ❑Existing Stnka res/buildings posed5huctures/Bulldings ❑Sewer li anks ❑Additions [T/orth A/rrow [QSfale Bar Applicant Signature ///YWI.�t-u1"�� Dad q(Z7/17 OFFICIALUSEONLY Departmental Review Approval lMls. Date Notes,Conditions,Related Permits Water Adequacy Sewer/Septic System Tenant Review Revision THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEBSITE 11eataa i IJn/2015 \ « y\ �y� §? % , � } \ \/ % 4 �« \ \ � a �a & G � ƒ { ee \ \ \ / ZE \ $ � > \ . . i y m - - - � 5 % 7 _0 -----p � ) § ƒ � . . - ) . - _ En } \ \ / \ \ \ rrl / _ MOR auJHOVE5 STEVE&___r-OWNER - 1e@ # mms EE o_ r s M 2 \�� � o� BELFAIP, «98528 _ _ _ --