HomeMy WebLinkAboutBLD2024-00866 - BLD CD Environmental Health Review - 7/18/2024 MASON COUNTY PermitNo:(h/� OC66b
COMMUNITY DEVELOPMENT ECEIVED
Permit Assistance Center, Building,Planning
BUILDING PERMIT APPLICATION 8 4 _
PROPERTY OWNER INFORMATION: C NTRA TOR INF RMATI N: 70 C
NAME: 60919 U W/cAy, oM NAME: D r } Ite 5 W. Alder St t
MAILING ADDRESS: VS [ MAE,I GADDRESu: b'O C - .YL v
CITY:D#KU11fe- STATE:td/f Z@: 9srtr CITY:0 &a STATE: ZR: 0 rw
PHONE#1: 3„O'Ylo^9366 PHONE yyy CELL:3(ao 237 72 01
PHONE#2: EMAIL: a DE rRA NG i C
EMAIL: L&I REG#- l# 9 iR
P-- f CONTACT: OWNERD CONTRACTOR OTHOI❑
NAME ,ice a T2A;EMAIL G<@ l�fTeri Cy GM.P'c m O
PHONE CELL
SAWS ' CITY —� nATE_ZIP r Z
CELL
PARCEL INFORMATION: = ITT
PARCEL NUMBER(12 Digit Number) 620O7d/400000 MNDIG z
LEGAL DESCRIPTION(Abbrtvieeed) FIRE DISTRICT
SITEADDRESs Z23 pr. G2/fKF.1d ae(YE Kd crrY P.Gca.ae4- r
DIRECTIONS TO SITE ADDRESS
ISTHEPRO3ECTWPPRTN3WnOFSLOPE(S)GREATERTRANI4%: YESO NORr SNOWLOAD:—Pef
ISPROPERTYWTTHRN2011 FTOFTHEFOLLOWOIG: fCM tonwf.py�;
SALTWATER[] LAKE[] RIVER/CREEK❑ PONDD WETLAND[] SEASONALRUNOFF❑ STREAMD
TYPE OF WORK: NEW B' ADDITION❑ ALTERATION❑Aa R�EFORM❑ OT}IER fl
USE OF STRUCTURE(Reekerm,C+ Cw.mertMel�,Es) R£S/..i'/VcL
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS_NUMBEROFBATHROOMS
FffATED STAUCrtIRE? YES(IlAdaefdy❑ YES( ,,/afXdv❑ NO[] —
DESCRIBE WORK
SOUARE FOOTAGE,rPrapa..da
1ST FLGOR p.ft 2ND FLOOR p.ft 3RD FLOOR_p.R BASEMENT_
it
DECK_p.IL COVEREDDECK_p.R STORAGE—al OTBEW—
p.ft
GARApE_p.R. Attached[] Deracbad 0 CARPORT p.ft Attached❑ Deeached
MANUFACTURED HOME INFORMATION: a4 COPIES OF THE FLOOR PLAN REQUIRED.
MAKE SRYL/,Yf MODEL R✓ WI/7-b YEAR 236 LENGTH_
WIDTH-2-7 BEDROOMS 3 RATES 'L SERIALNUMBER TBD
ENVIRONMENTAL HEALTH: �/
SEWAGFISEWER SOURCE: SEPTIC L7 SEWER❑ I NEW EXISTING[-
PLUMBINGINSTRUCTURE? YESIIr NO❑ 1fam attach cddiknd WaerAdequary Form
PERRIETERTOUNDATION RAINS PROPOSED? YES❑ NO@1 EHMNGSQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS _ TOTALBWROOMS .3
OWNEN rfnwdetlpes Mal sutmb¢bn Mlneminb Information may n¢Wl In a slop wmh utl¢rm pe�lnttlewoallm.Mk�xrv.M40emmd IXeucM1 b Ey
agnalure W.I declare Na11m he weer..) ,mad,decure mlb and I am tif to receive thispemllt and to do the w aepreadead.I hae,
.Clamed pmnWim kmn all Ne mreseuvy al Induding any eawnenl herder or names of Imemt Medi a,;Nis pans. The worm ell
e
repre¢enlamd,represents NM 1M IMmmeen g,, ided is axvrakeM gnnh empbyeesof Ma¢m Ccumy.cussla Ne aEow eadd.pa,e,
aM 68u ,.)for.vq nyerd'an.The eendw. plice0on Berard.nutl a wld NvM praultedmad doantctim is arnmemetl wared lee
dd,m ewnaWcHon vdk b auapeMM fat a de mad N tea days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATI 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08,42)
X
SlgneW OWNER Mual bee etl the OWNER Oeta
DEPARTMENTAL REV�W':'�' APPROVED DATE'.` DENIED_F"SLATE- TAGSMOTES/COMY]TIONS
BUILDING DEPARTMENT'
PLANNING DEPARTMENT
FBtE MARSHAL
PUBLIC HEALTH
-31
3 ,z y a 5 m. t1 # Q
4„ � Nv NO
EH Setbacks I
A.) Drainfield/Reserve requires 10'setback from footing/foundations
B.) Septic tank(s) requires 5'setback from all footing/foundations -
C.) No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
D.) No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reseme area -_ y-
EH APPROVED
Rhonda Thompson 08/1512024 Qp
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