HomeMy WebLinkAboutSPI2024-00054 - SPI Application - 5/16/2024 RECEIVE®
, MASON COUNTY MAY 0 SPI 202�1 - odos
COMMUNITY SERVICES 2024
Building,Planning,Environmental Health,Community Health W. AJder CAR V N E R G k V k N
615 W.Alder St.—Bldg.8,Shelton,WA 98584 V[rr,Q[
Phone:(360)427-9670 ext.352♦Fax:(360)427-7798
PLEASE PRINT $300.00 FEE REQUIRED
PLANNING DEPT. PRE-INSPECTION APPLICATION
Note:Pre-inspection does not survey lot lines and can only provide very general septic and water adequacy information.
1. Owner: ���'` a ma t Applicant: &ua k 1)1 kS
Site Address: Applicant ddre�s_:w Sit en ev
Owner dress: 3 UI(P kl.(/l Nul City: '' ` St Zip 9J j 6
City: UM vA t1 St W Zip OZ Phone:( 3 ) 8'8A' 3 5-7-7 day,,
Phone:(_) Email Address: �u V12 a (Ulu CI10-f 7� I��tM,&41
Email:
(if different than applicant) Legal Description: oJC 6ouT L6T 2
2. Parcel No. �510111 - .2 - 000-70
Parcel No. -
3. Purpose of Pre-Inspection: A:1Q a 1 I'dI'
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4. Use of building: Sj 4 w l� /444,k, a gk?-
5. Do any of the following exist on or adjacent to property?: slope 01� saltwater YV lake ) river )
pond( ) wetland ) seasonal runoff( ) other( ) stream ) seasonal creek )
Directions tq Site: C!z' a k to c 14 - 3
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If the information is incomplete, then Mason County must disclaim any errors resulting from deficiencies in the original
application. Pre-inspection reports remain valid only until development changes occur in the vicinity which affect the lot
evaluated in this inspection, or the laws regul g development of the site change after the time of inspection.
Applicant Signature: Date: l4�16., Zzq
If you would like to be on site during inspection,please check here: W
Return application to: Mason County Community Services,Planning Division
615 W.Alder Street
Shelton,WA 98584
(360)427-9670 ext.352
Please include a $300.00 check or money order payable to Mason County Treasurer
When completed,this form becomes part of the parcel file.
FOR OFFICE USE ONLY:Accepted by: Date:
MORE ON BACK SIDE
Rev. April 2021
Please illustrate below the proposed building site in relation to critical areas (slopes, streams, lakes, wetlands, etc.)
existing improvements, as well as property lines. APPLICATIONS SUBMITTED WITHOUT ADEOUATE
ILUSTRATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED TO THE APPLICANT.
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Departmental Review
(For Office Use Only)
Planning Department Findings:
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