HomeMy WebLinkAboutCOM2016-00104 - COM CD Environmental Health Review - 5/1/2018 MASON COUNTY PUBLIC HEALTH OFFICIAL USE ONLY
COMMUNITY DEVELOPMENT
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ENVIRONMENTAL HEALTH REVIEW
aI s N.Am sneer Shelton,WA 98584
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5601e27-9670,Ext and Dep)ns 44e7,Exraou � �20W• IDy
1.Applicant/Property Information
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North Mason School District �. 12208 22 60000
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71 E. Campus Dr., Belfair,WA 98628
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75 E. Campus Dr., Belfair,WA 98628
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Dana Rosenbach, Eric Nelson 360-227-2300 drer back northmawnschwls.or ,
2.Type of Review/Job 3.Job/Site Information edc hainline.net
p n❑ Residential ® Commercial ❑Tennant Review
® New ❑ Replacement ❑ Pre-Application 0 !�+ 0 ` 0
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❑ fle ter(explain below) sacwn, a.a°wo,
a wws ra.exwmm".eaamrr.wnhxenrmu
.Construction of a wncessions buildin
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A.On-$he Sewage System/Sewer Information N Al
nwgrswwaw P-111,71;
n.vraaorwnpn ONNo NryE On-Site Septic System E New ❑ Existingrn{Yryeer N/A N7A((f
❑ Sewer Connection E] New ❑ Evlsting
S.Water Source Infonnetlan
TBD-septic to be submitted July 2016 Plumbing in structure? ® yes ❑ No
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uum;aneximnq onsitesepur system will rocure a current maintenance report Please submit a completed Water Adequacy Form.
endanecord Drntingpebunn. Documeouhwbutbath,,erequiremenis may An incomplete submitted Water Adequacy Form may be
lnonfibwith Mason Coumy Public Hemh.Other reywrementsmay , returned,and hold up review process.
6.Site Plan -
A scaled Site Plan Is required Mich all permits,except interior remodels. An incomplete submitted she plan may be,returned,and
holdup review process. Paper sisefor she plan can be B.Sxl 1,8.504,or 1107(max). Please use checklist below:
0 Property lines/dimensions ❑Primary Drainfield area ❑Reserve Drainfield area [](Existing/proposed wells ❑Waterlines
❑Septic Tanks location ❑Locationo(curtain/perimeterdiains ❑Direction of Slope ❑Driveways/Parkingareas/Easements
❑Existing Structures/buildings ❑Proposed5tructures/Buildings []Sewer lines/tanks [:]Additions ❑North Arrow []Scale Bar
Applicant Signature ��- ti Data •�Z./E�
--------- Y __ OFFICIAL U5E ONLY
Departmental Review Aaproval Date Notes,Conditions,Related Permits
Water Adequacy r
Sewer/Septic System — -
Tenant Review
Revision
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MA50N COUNTY WEBSITE R,neh 11111.11