HomeMy WebLinkAboutBLD2023-01527 - BLD CD Environmental Health Review - 12/21/2023 MASON COUNTY Permit No: DLZO� t6P-7
COMMUNITY DEVELOPMENT RECEIVED
PurnItAssistmve Center,BuildiMPlanning DEC 2 0 2M
BUILDING PERMIT APPLICATION 615 W. Sftm
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Se< D I IR°9� NAME:�<ua.VYL1..ee�r,sir.ui.o�
MAILING ADDRESS: MAdM ADDRESS:On -( c400 M
CITY: STATE: ZIP:_ CRY: SfATE:1.1A AP: QQ SOq Z
�f PHONEAI: PHONE. - -qA CELL: -- <
PHONE 42: EMAIL: i+
EMAIL: L&I M#G EXP.Q/f (L•f = �J
PRIMARY CONTACT: OWNER❑ CDNTMCFOR� OTRERD m O
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PARCEL INFORMATION: G, Z
PARCELN"U(12Dign N.r )L(1903 -34 -5LD31 20NDJG �2
LEGAL RBT DFSCIION(Abbrevia d) FDlED6TRICF
SITEADDRESS CITYCI.A. 4n j
DIRELTIONSTO MTE ADDRESS } w f/� J` `I'
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m TREPR WR131N3NnOFSLOPE(S)GRFATERTBANII%: YFSQ NO MOWLOAD:2psr
5PROPERTYWRUU?2NFTOFTHEFOWAWDiG: (nae.xMmwMU�
SALTWATER❑ LAKE❑ RIVER/CREM[l POND❑ WETLAND❑ SEASONALRUNOFP❑ STREAM❑
TYPE OF WORK: NEW b ADDITION❑ ALTERATION❑ REPAIR❑ OTRER
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ISUSE: PRIMARY SEASONAL❑ 1 /NUMBEROFBEDROOMS NUMBEROF BATHROOM
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NEATEDSIRUCNRL: YFS MNe e,ly1y.a YFS IAA/v]Naupl❑ NOD
DESC EWORK� W /r2G H �
SQUARE FOOTAGE:1papu/I
ISTFLOORldl-L k 2NDFLOOR_,.1L 3RDFLOOR_,k BASEMENT=y.R
DECK_5_1�p.tl, COVEREDDECK q.R STORAGE 'aq.R OTHER,`K.R
GARAGE -Tr.RAlwaa[l lM [3 CARPORT p.R AtmWD DnaoAedD
MANOFACTURED HOME INFORMATION: e1 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL5I07T'� YEAS ZQ7!, _LENGTH
WIDTH BEDItOOMS BATHS Z- SERIALNUMBER TS.D
ENVIRONMENTAL HEALTH: 1 '
SEWAGFIEEWERSOURCE: SEFT`C PJ SEWER❑ 1 NEW EXISTING[I
pLUMR1NG RI STRUCTURE? YFS fR/ NO 1(ym,e4xMroml Ware Ad,, £om
PERDABIENFOUNDATION DRAINS PROPOSED? YES My/p EXISTING SQ.
EKIBTIIIGBEDROONS PAOFOSEDBEDROOMS—:L—!� TOTALBEDROOMS
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PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF TIES
PERMIT APPLICATION OF IN DAYS OF MORE WILL CAUSE THE APPUCAUON TO BE EXPIRED.(MAKIN
COUNTY CODE 14.09A2)
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SI3ne of ORNER(Moat M sionaE by Ux ONNER) Deb
--1)$PARTME4fTAjBEV¢W ' APPROVED I DATE I DENIED :.DATE, -TAGEMOTESXONDMON
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBUC REALTx wit
M soh COUNTY
RECEIVED
CONIMUNITY DEVELOPMENT
DEC 2 0 2023
BUILDING PERMIT APPLICATION
-615W. Adder Sbftt
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EH Setbacks
A.) Drainfield/Reserve requires l O'setback from loofing/foundations
B.)Septic tanks)requires 5'setback from all footing/foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
1= D.)No Cut Bank(s))greater than 5ft and over 45 degrees)within 8e�
5011,down gradient of Drainfield/Reserve area
X - Audio- isu Alarm
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S EH APPROVED
j Rhonda Thompson 03/01/2024 ' 'I 1200 Gallon Septic Tank
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Effluent Filter WELL
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O O Valve Control Boa j
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