HomeMy WebLinkAboutBLD2011-00588 - BLD CD Environmental Health Review - 8/12/2011 MASON COUNTY
DEPARTMENT OF HEALTH SERVICES p y
August 12, 2011 PO BOX 1666 Shelton WA 98584
Shelton (360)427-9670
Fax (360)427-8442
JUANESTEBAN Elma (360)482-5269
PO BOX 295 Belfair (360)275-4467
BELFAIR WA 98528
Case No.: BLD2011-00588 Parcel No.:122057800010
Dear Applicant:
Your building permit will not be approved by Mason County Public Health until the following
items are completed and received in our office.
Satisfactory Operation and Maintenance report from a licensed Operation and
Maintenance Specialist with in the last year.
Please call me at (360)427-9670, ext. 279 if you have any questions.
Sincerely,
Amanda Reynolds
Environmental Health
Mason County Health Services
Comments:
811212011 Page 1 of 1 BLD2011-00688
COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Official use only
�y1
415 N.6th Street Permit Number:
PO Box 1666
Shelton,WA 98584 Date Received:
Shelton: (360)427-9670, Ext.400
Belfair: (360)2754467 Ext. 400 Amount Received
Elma: (360)482-5269 Ed.400 Receipt Number
Fax (360)427-7787
Applicant-Information Type of Review
Applicant ZSAD V\ F-t, i.✓1 Datea"I3J X Building Permit I
Mailing Address 0 New 0 Replacement"
Qjp A-CUIr kA {,. A52D 0 Commercial Building Permit
City State Zip
0 New 0 Replacement
Daytime Phone Other Phone 0 Building/Commercial Permit Revision
0 Tenant Review
E-Mail Address 0 Pre-Application
Parcel Information
12-Digit Parcel Number — 10
Site Address �.� l — CLV r
Street Number Street Name City
Type of Job ``�� Please submit a scaled plot plan
Describe work -n ClCIA i�1r showing all existing and proposed
Number of Bedrooms building, on-site sewage system,
and well.
On-Site Sewage Information ���,,,rrr +�Water System Information
On-Site Septic System 0 New Existing Plumbing in structure? d Yes �No
0 Sewer Name of Sewer System If yes:
Using an existing on-site septic system will require a current Please submit a completed Water
maintenance report and a Record Drawing (Asbuilt). Documents Adequacy Form.
for both of these requirements may be on file with Mason
County Public
cHealth. Other requirements may apply.
Applic�ant JlSure[ ✓ YYI 4�� ] �3 Date
l
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
Revise 12117109