HomeMy WebLinkAboutBLD2011-00372 - BLD CD Environmental Health Review - 5/10/2024 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Official use only
415 N.6th Street permit Number. 7 1da01I-Cb34Z PO Box 1666
Shelton, WA 98584 Date Received: S-IL)-ZU)
Shelton: (360)427-9670, Ext.400
Belfair: (360)275-4467 Ext. 400 Amount Received
Elma: (360)482-5269 Ext.400 Receipt Number
Fax (360)427-7787
Applicant Information Type of Review
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Applicant Ma✓+1r. fro+e Date
6 1 X Building Permit 'j'�Ag
Mailing Address 03 L 'Mr-aln A 5B 0 New 0 Replacement
Re I1,r\ R q-W S — 0 Commercial Building Permit
0 I City State Zip O New Rep]
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4asa3S-4S3`b 0 Building/Commerci erml ReVlSMift
Daytime Phone Other Phone�glg -13"13 MAYIO2
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E-Mail AddressTenant Review,,-�r,r�,, ,„n�-.-F ne� 0 Pre-Application Q�i
Parcel Information
12-Digit Parcel Number 3aa D t0 —oa�l rd �00
Site Address E. 1 O 11.,H n Rve
Street Number Street Name City
Type of Job Please submit a scaled plot plan
Describe work �tn�sh 1'7�Se= o.-}�F'^'Sl '9 showing all existing and proposed
Number of Bedrooms r8 building, on-site sewage system,
and well.
On-Site Sewage Information Water System Information
0 On-Site Septic System 0 New W Existing Plumbing in structure? Yes 0 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
for both of these requirements may be on file with Mason Adequacy Forth.
County Public Health. Other requirements may apply.
Applicant rgn�u 1
Date
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
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