HomeMy WebLinkAboutBLD2024-00459 - BLD CD Environmental Health Review - 4/12/2024 MASON COUNTY Permit No: r/Ida1)' " -mq-�rI
COMMUNITY DEVELOPMMUEIVED
Permit Assistance Center, Building,Planning APR 09 2024
BUILDING PERMIT APPLICATION 615 W. Alder Street M
PROPERTY OWNER
/INFORMATION: CONTRACTOR INFORMATION:
L.NAME: a. 66 C�<a -y.S NAME:HIune Homes m
MAILINGADDRESS: P.O leak Z 2 MAILING ADDRESS:113M servo AV E D
CITY: 0 Nw, STATE:tt4 ZIP:Mdii! CITY:mnuluP STATE:VIA ZIP:983"
PHONE#1: ;&C>-4/90 —2AH'7 PHONE:ma-nuazaa CELL:
PHONE#2: O — I O — S2 7 1 EMAIL:ae<"^rl"Klb"®nl°"ehom.em"
EMAIL: -/JjdP a L&I REG#HI.NH g83e0 EXP. 11 18 /25,.
PRIMARY C NTACT• OWNER CONTRACTOR❑ O HER❑
NAME o a a { EMAIL ^S t .o+ C 14'1
MAILINGADD�D. fak Z-&9 _ CITYVA,IA61 STATE" ZIP
PHONE CELL 5&C-d90 —?R47
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3/RON'ld/- %a�10 ZONING PCt P
LEGAL DESCRIPTION(Abbreviated) SP-4 ISI FIREDISTRICT L r'
SITE ADDRESS_&F /t, CITY » t
DIRECTIONS TO SITE ADDRESS a LC , ItJ
( � 1a t5,/L- rvta ar f rVJJ
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOA SNOW LOAD:ZCPaf
IS PROPERTY WITHIN 200 FTOFTHE FOLLOWING: (Check all rhnrapply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND WETLAND SEASONAL RUNOFF STREAM ❑
TYPE OF WORK: NEW)( ADDITION❑ ALTERATION ❑ REPAIR❑ OTHER
USE OF STRUCTURE(Re,id sce,Geroge,Conamm dEldg,Etc.)
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS?• S
HEATED STRUCTURE? YES(IPhols E/dg)Z YES(Pan[,)gfBW❑ NO❑
DESCRIBE WORK Srn /
SOUARE FOOTAGE: (prWe,ed)
I ST FLOOR.?,�sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK_TV�sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE�L sq.ft. Attached g Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: •4 COPIESA01 TFIEk
kOOR PLAN REQUIRED•
MODEL YEAR L H
IDTH BEDROOM BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC.V SEWER❑ / NEW EXISTING ❑
PLUMBING IN STRUCTURE? YES R NO ❑ lJyes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES]a' NOD EXISTING SQ.FT
�EXISTING BEDROOMS PROPOSED BEDROOMS •�TOTAL BEDROOMS
OWNER acknowledges Mal submission of inaccurate information may result In a gap work order or permit revocation.Acknowledgement of such is by
signature below.I decare Mat I am the owner and I further declare Mal I am entitled to recelve this permit and to do Me work as proposed. I have
obtained permission from all the necessary parties,Including any easement holder or parties of interest regarding Mk project. The owner or legal
representative,represents that the information provided Is accurate and grants employees of Masan County access to the above described property,
and structure(s)for review and inspection. This permlaapplication becomes null&"id Hwork or authorized constru chon is not commenced within 180
days or d construction work is suspended for a period of 180 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
COUNTY CODE 14,18.42)
X _12_02 4
Signature of OWNER(Must be sinned by the OWNERI Dale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES[CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH L ktS
�n !� p S S 1 T [ I. A IJ
PLN SETBACKS
Front (East): 25' PLN Approved
Sides: 20' 04/18/2024
Mason County Community Development
Rear: 20' Gavin Scouter,
.all setbacks measured from the farthest 7_ (pGr r All Changes Subject to Approval
projection of the building
'subject to EH setbacks
NOT AN APPROVED SEPTIC DESIGN EH APPROVED
Must use SWG 2024-00092for septic installation Rhpnea Thompson 0512WO24
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B4f ldr� !z f> /Y'Z
U : H6'At rtw .w rF EH Setbacks
iA) Dra nlielNReserve r uiras 1 o'semack from tcotinylou Batons
3 5 selbackfrom all l000wngraneatiof
C. Np lountlatioNPeem ter Dracack from 30lt tlovm 2ndabo l
DminilelNReaerve area
Pam+�. D.)No Cut Bankjs)(gresin than 5X and over a5 degrees)vnmin
SOX,tlown gratlient of 0 InM1eINReserve area
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