HomeMy WebLinkAboutCOM2018-00129 Vault Toilet - COM Application - 2/3/2020 MASON COUNTY COMMUNITY SERVICES Permit No
UIL
PERMIT ASSISTANCE CENTER:
B •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 1 L"
615 W.Alder Street,Shelton,WA 98584
f Phone Shelton:(360)427-9670 ext.352-Fax.(360)427-7798 Phone 7
Belfair.(360)2754467-Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION 6Afl
s �e Street
PROPERTY OWNER INFORMATIOrN: CONTRACTOR INFORMATION:
� EI\/E®
NAME:W f=LCh - 1�1 NAME: V 112018
MAILING ADD SS: Y)r ti1t�,(th MAILING ADDRESS: l
CITY:OL l STATR W A ZIP. $$p I CITY: STATE:W A ZIP: , Alder Street
PHONE# . 3.1e -9o2-$39Q PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: r L&T REG# EXP.
PRIMARY CONTACT: OWNER 5J CONTRACTOR❑ ,OTHER❑
NAME EMAIL C Ifl O
MAILING ADDRESS fAM CITY STATE ZIP
PHONE_&W -g3 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)_I�, q-30-OTo00p ZONING RLtrQQ
LEGAL DESCRIPTION(Abbreviated)S 'LY OF *Wy.300 A FIRE DISTRICT $yp
SITE ADDRESS N,A RoeSSBI Rd . CITY (�
DIRECTIONS TO SI E ADDRESS Fram Muff(FIB,-tuyin W ATtha yrmSSek U ar)rl ED Row,
e LA of vixd 0aiT$A-
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO M
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkall that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW® ADDITION❑ ALTERATIION❑ REPAIR❑ - OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) 11 (/[�T �,1�
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(7f4iole Bldg)❑ YES(Part[s]of Bldg)❑ NO JR
DESCRIBE WORK Inn Y 1/
SQUARE FOOTAGE:(propose+existing)
1 ST FLOOR__g_y_sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: 5EE 51� 2015-003`�
SEWAGE/SEWER SOURCE: SEPTIC 19 SEWER❑ //V� NEW 5d EXISTING N T&#IV on,
PLUMBING IN STRUCTURE? YES❑ NOR Ifyes,attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NOW EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of Inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do thework as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of Interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permittapplication becomes null 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Sig a re of OWNER us be! red b the OWNER Date
DEPARTMENTAL REVIE APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT Z
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
Qg
RECEIVED �
NOV. 1 1 Z018 PROJECT LOCATION
615 W. Alder Street
I
13) 13oa1 PLANNING:
N BREMERTON ALL SETBACKS ARE MEASURED STATE MAP
PLANNING FROM THE FURTHEST
NOT TO SCALE
PROJECTION OF THE BUILDING
r SING
1 fi61 'T NNia 63
300 N Rt f
W BELFAIR VALLEY RD
GORST
NE BEAR CREEK '• _
fff rrr ' J1�_
DEWATTO RD 316
SW OLD CLIFFON RD FERNWOOD I"j PROJECT LOC ION \yam
q
cm—
CAv-4-,eA-- '/
m
3 SIN LAKE FLORA DR m j
r .
300
o '«
f :
BELFAIR
NE.ROESSEL RD
106 PROJECT LOCATION --i
s
RO SE PINE RD
302 0 !
1 '
3
LOCAL MAP
VICINITY MAP NOT TO SCALE PROPERTY INFORMATION:
NOT TO SCALE ADDRESS:
COUNTY: MASON
PARCEL#: 1232930006000
TOWNSHIP: 23
RANGE: 1
SECTION: 29
° 1 UNION RIVER — WATER ACCESS PROJECT NO.
WASHINGTON STATE BAR MEASURES
ONE INCH ON MN:A646:18-2
ORIGINAL DRAWINGS DFVtiF — STATE WIDE TOILETS
SYM DATE REVISION DESCRIPTION BY DESICNM BY SHEET OF
DEPARTMENT OF FISH AND WILDLIFE APPROVED AND RELEASED FOR CONSTRUCTION CHECKED TOILET REPLACEMENT
BY
CHIEF ENGMEER..........................................................DATE........................... DRAWN 8Y S.ASHLER 1 2
PflOGRAM .....................................................................DATE...........................
DATE 09-06-18
UNION RIVER
OHW
/ - - _ \1
�+I EXISTING PICNIC
TABLES \ \
// \`;,\
EXISTING TOILET / / \��\
TO BE REPLACED
� I �
• II I
EXISTING GRASS
AND VEGETATION
EXISTING GRASS
AND VEGETATION
PARCEL®: 123293000600
- EXISTING SIGN // /
NEW INS VAULT TOILET
TO BEE INSTALLED
I
/ l PROPERTY LINE - - -- --- -
- GRAVEL DRIVEWAY
/� TO GRP�1,P�K1N0 EXISTING CONCRETE \
PROPERTY LINE PARCEL®: 123325000087 PAD
EXISIING I �AIL I AND VEGETATION
TO PARKING
� I GRPHEI.
CXT VAULT TOILET LOCATION: SITE FLAN
LAT: N47' 26' 55.9779", LONG: W12T 50' 2.841'
° 1 UNION RIVER - WATER ACCESS PROJECT NO.
WASHINGTON STATEBAR MEASURES
ORIGINAL
INCH ON MN:A646:18-2
DRAWINGS DFW - STATE WIDE TOILETS
r SYM DATE REVISION DESCRIPTION BY BY SHEET OF
CHECKED 6Y
DEPARTMENT OF FISH AND WILDLIFE APPROVED AND RELEASED FOR CONSTRUCTION ODESIGNEDDESIGNEDTOILET REPLACEMENT CHID'ENGINEER................................................................OATS. ER 2 2........................... DRAWN BY S.ASHL
R!IX'RAY .....................................................................DATE........................... OAIE
09-O6-1B