HomeMy WebLinkAboutBLD2024-00387 - BLD CD Environmental Health Review - 3/25/2024 MASON COUNTY COMMUNITY SERVICES Permit No: &PoFLD`�24-003, "7
PERMIT ASSISTANCE CENTER:
•BUIIDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED
615 W.Alder Street Shelton,WA 98584
Phone Shelton:(360)427-9670 e#. 352•F.,(360)427-7798 Phone ENWRONMENTAL
Berfair(360)275-0 67•Phone Elms:(360)482-5269
c4p) BUILDING PERMIT APPLICATION 615 WifiAlUkiet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:'���el,r ^' Kar�o MiJy2M F,V NAME: �• /..�
MAII,AIG ADD— ES v�W' MAILING ADDRESS:
CTI'Y:l�,q�m oP 1 STATE: L� ZIP: S 1 CITY: STATE: ZIP: t7
PHONE#1: '�(oU - '�:'�Z- Srx'i PHONE: CELL:
PHONE#2: 34o C7 - J' ''—l� - �+' I O EMAIL : 2
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EMAIL: u � - P_vv..=V ® m a', . eo L&I REG#
PRIMARY CONTACT: OWNERN CONTRACTOR❑ OTHER❑
NAME N EMAIL �o2M m�+-+u mP.rl��r 4�MA11 COM
MAILING;DDRESS\ CITY 01. ,✓,eScl STATE
PHONE CELL 360- OWL- O5
PARCEL INFORMATION: ►� /��
PARCEL NUMBER(12 Digit Number) 51 q 01 -S L- 010 10 ZONING 1e.1�.+
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT Is
srrEADDREss 51 w Lo S} 14�e_ v;a,J dr. CITY S%�.a1i6 ✓
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%; YES❑ NOIR snow: 25 p 6'f
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (check aR dmr appo:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW M ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Rsaideece,Gmvge,ewnmerdel B(dg.Ew) .r7 ho(p W �yt 1•y"oa 5 P^t-,-
IS USE: PRIMARY'® SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Wkoletudg)Q YES ryanpl oJBW O NCI(]
DESCRIBE WORK , s
'µ SOILARE FOOTAGE: IProPaae+ertrrlagl
N
^,t 1ST FLOOR sq.R 2ND FLOOR I O`7,,`` sq.R 3RD FLOOR sq.ft BASEMENT sq. ft.
N DECK sq.ft. COVERED DECK Z`'I U sq.ft STORAGE sq.ft. OTHER sq.ft.
Z
GARAGE—sq.ft. Attach Detached❑ CARPORT sq.ft Anached❑ Detached❑
AlANUFCTJJRED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN RE D* ,1
MAKE MODEL YEAR L
WIDTH BEDROOMS SERIAL
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC SEWER❑ / NEW" EXISTING❑
PLUMBING IN STRUCTURE? YES 0 NO ❑ If)w;attach completed WaterAdepmry Form
PERNIETERNOUNDATION DRAINS PROPOSED? YES X, NO[] EXISTING SQ.Fr.
EXISTING BEDROOMS PROPOSED BEDROOMS I TOTAL BEDROOMS
OWNER acknowledges that submission of i oc:urate iMamabon may result In a stop work order or permit revocation.AdmoWedgement of such is by
sigreture below.I declare dust I am the ovmer and I fuller declare that I am entitled W receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties.Including any easement holder or parties of Interest regarding this project The ovmer or legal
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EH Setbacks
A.) Drainfield/Resame requires l0'setback from lcotmngdun oundations EH APPROVED
B.)Septic tank(s)requires 5'setback from all footinodations
C.)No foundatiowPerimeler Drains within 30ft,downgradient of
Drainfield/Reserve area Rhonda Thompson 05/24/2024
D.)No Cut Bank(s)(greater than 5f1 and over 45 degrees)within
50It,down gradient of Drainfield/Reserve area