HomeMy WebLinkAboutBLD2024-00614 SFR - BLD Application - 5/16/2024 MASON COUNTY COMMUNITY SERVICES Permit No: L --DOCo/4
PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED
615 W.Alder Street,Shelton,WA 98584 Phone Shelton:(360)427-9670 ext.352•Fax.(360)427-7798 Phone MAY 16 6 2024 �
Benir.(360)2754467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION 615 W. Mar Skvet C
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: t�
NAME; Lennar Northwest,Inc. NAME: Lennar Northwest Inc.
r '
MAILING ADDRESS: 33455 6th ave S.Unit 1-13 MAILING ADDRESS: 33455 6th Ave S,Unit 1-B �•
CITY: Federal Way STATE: WA ZIP:98003 CITY: Federal Way .. STATE: WA ZIP: 98003
PHONE#l: (253)294-1322 PHONE:(253)294-1322 CELL: (253)294-1322
PHONE 42: EMAIL: Sam.Martin(dLennar.com
EMAIL: Sam.Martin(a,Lennar.com L&I REG#LENNANL783JO EXP. 3 /18/24
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER N 0
NAME Sam Martin.Agent for lennar EMAIL Sam.Martin@Lennar.com
MAILING ADDRESS 33455 6th Ave S.Unit 1-B CITY Federal Way STATE WA ZIP 98003
PHONE (253)294-1322 CELL (253)2944322
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 12328-51-00128 ZONING
LEGAL DESCRIPTION(Abbreviated) Olympic Ridge FIRE DISTRICT
SITE ADDRESS 200 NE Olympic Ridge CITY Belfair
DIRECTIONS TO SITE ADDRESS
O IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOR SNOW LOAD: 5 00 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checxalt that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
Q TYPE OF WORK: NEW R ADDITION❑ ALTERATION❑ REPAIR❑ OTHER R
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc New SFR using approved stock plan 42018-0024 Plan 2121 MF GR
IS USE: PRIM[ARY-54 SEASONAL❑ NUMBER OF BEDROOMS 4 NUMBER OF BATHROOMS 2.5
HEATED STRUCTU�E? YES(n.Io Bldg)❑ YES(Part[s)ofBldg)R NO❑
DESCRIBE WORK New Single Family Residence heated and garage unheated
_ SQUARE FOOTAGE:(proposed)
1 ST FLOOR 899 sq.ft. 2ND FLOOR 1223 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft
(� DECK sq.ft COVERED DECK_sq.ft. STORAGE sq.ft OTHER sq.ft
J GARAGE 591 sq.ft. Attached] Detached❑. CARPORT sq.ft Attached❑ Detached❑
J MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
—1 MAKE MODEL YEAR LENGTH
r
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER® / NEW® EXISTING❑
PLUMBING IN STRUCTURE? YES® NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES N NO❑ EXISTING SQ.FT. 1540 sgft
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 the work 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 peimit/applicetion becomes null&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)
X 7eaA&;y 8/17/2023
Signature of OWNER(Must be signed by the OWNER) Date
.DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT V& 7-12
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
MASON COUNTY COMMUNITY SERVICES Permit No:I;Lj e1`:;::�M4'0a&
PERMIT ASSISTANCE CENTER.
•BUILDING •PLANNING •FIRE MARSHAL RECEIVED
`�.�D
615 W.Alder St-Shelton,W Gv
A 98584
www.co.mason.wa.us MAY 16 2024
Phone Shelton:(360)427-9670 ext.352• Fax:(360)427-7798
Phone Belfair.-(360)275-4467• Phone Elma:(360)482-5269
615 w. Alder Street
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Lennar Northwest,Inc. NAME:Lennar Northwest,Inc.
MAILING ADDRESS: 33455 6th Ave S Unit 1-B MAILING ADDRESS:33455 6th Ave S Unit 1-B
CITY:Federal Way STATE:WA ZIP: 98003 CITY:Federal Way STATE: WA ZIP: 98003
1'.PHONE: (253)294-1322 PHONE: CELL: (253)294-1322
2nd PHONE: EMAIL : Sam.Martin(a,Lennar.com
EMAIL: Sam.Martin(d)Lennancom L&I REG# LENNANL783JO EXP. 03 /18 /24
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): 12328-51-00128 Zoning:
LEGAL DESCRIPTION(Abbreviated):' Olympic Ridge
SITE ADDRESS: 200 NE Olympic Ridge CITY: Belfair
DIRECTIONS TO SITE ADDRESS:.
TYPE OF JOB:
NEW x ADD ALT REPAIR OTHER USE OF BUILDING New Single Familt
LOCATION OF FIXTURES/UNITS—1ST FLOOR x 2NDFLOOR x BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No.of Fixtures Fees Fuel Type:Electric x LPG Natural Gas Ductless_
Toilets 3 !We of Unit No.of Units Fees
Bathroom Sink 4 Furnace
Bath Tubs 1 Heat Pump 1
Showers 1 Spot Vent Fan 5
Water Heater 1 Propane Tank
Clothes Washer 1 Gas Outlets 1
Kitchen Sinks 1 Wood/Gas/Pellet Stove
Dishwasher 1 Kitchen Exhaust Hood 1
Hose bibs 2 Dryer Vent 1
Other Solar Panel
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge 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,owners legal representative,or contractor.I further declare that I am entitled to receive this
permit and to do the work 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 authorized agent 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 permit/application becomes null&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 OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL INVALIDATE THE APPLICATION.
x sa';�7g4z,t� 8/17/2023
Signature of Owner Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT DEC -7-1•7-
PLANNING DEPARTMENT
FIRE MARSHAL
Rev:1/27/2016 JBN
Name Sam Martin,Agent for Lennar Parcel# 12328-51-00128 BLD#_�p��
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development,or redevelopment',with more than 2,000 square feet of impervious surface 2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
T,0 04ky ate ;pet rou urfa c s Ple se
°� ., �_.
Surface Type Length X Width = Area *All dimensions in feet
Buildings X =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
X _ above table
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X = '
X = If fhe41totalmpernous area ofle proposed sie ,
X _ developmeratis greater than 2QQO sgciare feet a,
H, � H Small Parce)3Stor'mwaterSate Play �sRequ�red
k
Total lmperiotas Surface Area(hum t�f atl areas) ' xtd,
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent 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,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X,��� Owner/Agent/Contractor(circle one)Date: 8/17/2023
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
Name Sam Martin,Agent for Lennar Parcel# 12328-51-00128 BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
http//www.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to "Title 14,Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document
entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan".This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details*are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) X An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at:
Phone:(360)-427-9670 EXT.450
100 W PUBLIC WORKS DR
SHELTON,WA 98584
If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other,parcel.You may also wish to consult with the septic design professional involved with the project.Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT.352
615 W ALDER ST
SHELTON,WA 98584
A condition will be added to the building permit that states,in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent 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,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Sam Martin,Agent for Lennar Owner/Agent/Contractor(circle one)Date: 8/17/2023
Page 2 of 2
EH APPROVED Public sewer and water BUILDING SETBACKS:
FRONT: iV SIDE 5' REAR: 10'
Monda ThomD.n 05/31l2024
N1512'45"W 60.09'
I I I TCE =INSTALL TEMP. CONST. ENTRANCE
t I
u I I TSS =INSTALL TEMP. SOIL STOCKPILE
hLO
I -- BSBL LO
PROPOSED (TYP)
I
to I M I I CONTOURS I ;� M
•� � I ! TSS 'r
4 I I t Z
I I
"R-5"Medium density residential district
12.7 ' — — — 17 33'i Front yard:10 feet.
Side yard:5 feet for accessory structures and 5 feet for the
W dwelling unit.
Z I J I Street side yard:10 feet.
4 I I Rear yard:5 feet for accessory structures and 10 feet for the
HS128 I ! _ dwelling unit.
PROPOSED I cv Street rear yard:10 feet.
SFR
o L_ — jo 3' 05/16/2024
U � ! APPROVED
FE 12121 M F I I EAVE MASON COUNTY DCD PLANNING
SCM WfDY,AICP
i GARAGE R o
N
0 BUILDING
I Digdatly
Q 27' CONC. I ENVELOPE
DRIVEWAY 33' isco
7,
3
.•::.::�: I ue y.
I
-' a :WALK''�•':��': �:`. `.` •';;,.:;::;;:::::
r
Go
o t STORM
INSTALL SIL E CE, I STUB
STRAW WATTLE, OR '��Jk, ; ;::;:;::`:
FUNCTIONALLY EQyI
! .; ;° ;._': ',':''•j. SOIL AMENDMENT NOTE:
L=62.80 TCE SEE BMP T5.13 "POST CONSTRUCTION
R=40.00' SOIL QUALITY AND DEPTH", WSDOE
A=BW57'02' WM STORMWATER MANAGEMENT MANUAL
SIDEWALK FOR WESTERN WASHINGTON.
I
--- --- SEPARATION NOTE:
ADA RAMP ANY PORTIONS OF STRUCTURES WITH LESS THAN
i N1512'45'W 20.03' 10—FEET OF SEPARATION SHALL BE FIRE RATED.
I
NE OLYMPIC RIDGE POWER TRANSFORMER SETBACK NOTES:
1. MINIMUM DISTANCE FROM ANY POWER
TRANSFORMER TO ANY DOOR, WINDOW, ON ALL
NON—COMBUSTIBLE MATERIALS SHALL BE
LOT SIZE = 6,562 SF 8—FEET.
IMPERVIOUS 2. MINIMUM DISTANCE FROM ANY POWER
TOTAL IMPERVIOUS: 2,861 SF (43.6%) TRANSFORMER TO ANY COMBUSTIBLE WALLS OR
ROOF: 1.720 SF ROOF SHALL BE 10—FEET.
DRIVEWAY: 995 SF FLAT WORK NOTE:
WALK: 38 SF LOT COVERAGE = 1,720 SF (26.2%) FLAT WORK IS SHOWN FOR ILLUSTRATIVE
PATIO: 108 SF (INCLUDES EAVES) PURPOSES ONLY. FINAL CONDITIONS MAY VARY.
Job Number ° 10 20 40 LENNAR NORTHWEST LLC.
21885 srofe 1'=20'
Barghausen OLYMPIC RIDGE
Sheet Dmrm Dbriggs Consulting Engineers,Inc. HOMESITE 128
18215 72nd Avenue South PARCEL NO. 12328-51-00128
Kent,W 98032
1 of 1 Date 12/6/23 425251.6222 barghausen.eom 200 NE OLYMPIC RIDGE, BELFAIR, WA
File:P:\2100Ds\21885\lot\21885-0lympic Ridge—Plot Plans.dwg Plot Date/Time:12/6/2023 4:12 PM DBRIGGS
WAT_20oJ4 - 002z2�5 .
415 N.6'".Street
MASON COUNTY Shelton..WA 98584
• COMMV* NITY :SERVICES Shelton:360a27-9670,Ext.400
Belfair:360-275-4467.Ext.400.
&i0ding;:P{arming,EnvnonmenW Health,Community Health. E ma:,30-482-5259,,Ext.400
m
Application for Deterhmnation:of Water Adequacy"
Instructions
1- Complete PartI. No determination can be made until Part 1 is fully completed.
2: Comp.let'e only the:portionof Part 2 applying to theaype of water connectiort"utilized:
3.. Submit completed application,With.any`required attachments for review.
4:: An a roved_buildin`sit6 plan musfaccompany this,application.
Parf;1: Applicant/ Parcel Identification
Name m Applicant: Sam Nlactin,Agent for L"ennarNorthwest;inc Date; 8/11/2023
Mailing;Address: 33455 6tn Ave'S:Unit 1-B,Federal Way,WA,98003 Phone: (253)-294-1322'
Parcel.Number: i2s2MIwOo12s- "EorFutureAt9129
Type.of Water System: Reason for Application
Public/Community Water System(2or-more ® Building permit 13LD90a4-00(al�
,connections) U Division of land:
o Individual Water source(One connection.), #'of Parcels.? SPL
Well 0 Boundary line adjustment
0 Springlsurface Water 0 Other(explain) 0Other"(explain)
O Replacement or Remodel(please indicate name
1f you.have snore than one;residence connected of:water system below if applicable:--no
,to this.well,check the PublicXbmmunitywater signature required)
.System box
Part 2: Water.Connection In
Complete the.section appropriate for the type.of water connection being:evaluated:
Public Water System
Name of Water System: I -W"r � ESlY.c •� a,
Water Facility Inventory(WFI)Number: 053S
(write"none"for two-party)
1 am the manager of this.water system.The water system has been approved for services.
There are presently,��connection(i)in use This will be"the. connection.
0 I am the manager of this system.This.connection will.be to upgrade or change the use of an existing
connection on this system(Le.: recreational to full time)..'Please indicate on the following line'the nature
of this change:
This water system is able`.and willing to.provide water to this (these)connection(s.)without exceeding
the limits of the water system:or a im .set by state I cal regulation.
Signature of Water System Manager Date lb 1 ;z a1
This form maybe scanned and available for public view at www.co.mason.wa.us.
JREH.For nsl Drinking Water Revised 4/4/20I8
Individual Water Well
❑ Water well report(attached to application). Depth ft.
❑ :Well capacity Test(attached to application) gpm gpd.
The well:driller often performs well capacity tests at-the time_the--well is.constructed. Results from
these tests are noted on the water well report: Results'from these tests will be accepted. If`thewater
well report cannot be located by the applicant or if the water well report•does not have a capacity test,
a well capacity test,.which provides stabilization of draw-down and recovery data, must be,performed
by a licensed contractor.
❑ Satisfactory bacteriological:test(attach to application).
Water.Resource.Inventory Area(WRIA)
Development within,which WRIA http:/[Ais.co.mason.wa.usll?lganiqg 14_ 15=16_22.
Water.use.or limitation recorded:, ... . .....:.............. NIA Yes
Well Drilled - Date
Individual Spring/Surface Water
❑ WDOE permit(attach to application)
❑ Method of disinfection
❑ 1 have:reason to believe that this water source can provide at least 800 gallons per day;.and/or
provides water at a.rate of.2 gallons per minute.based on the following observations.
Author of Statement Date' .
Relationship to Applicant
Part 3: Mason County Community-Services-Evaluation (staff use only)
Satisfactory Determination::
This determination:does not address adequacy of the distribution system,guarantee an adequate supply of
water indefinitely in the future,or guarantee:compliance with all applicable WDOEEwater resource regulations.
RecommendeOpproval indicates requirements of Sanitary Code;Title 6',;Chapter 6.68.040=Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter.
36.70A RCW.
El Unsatisfactory Determination:
Applicant's Water supply does not appear'adequate to meet the needs of its intended use for the following
reason(s).
Reviewer's Signatures:
Environ. Health: Date
This form may be scanned and available for public view at www.co.mason.wa.us.
Page 2 of 2
S
400519
E
T 415N.6TH STREET BLDG B SHELTON WA08564
S;k LTQN 3fi 7 9676,EXT 460
MASON COUNTY
• T �i BELFAIR Std 275-W7,EX,T.,400
C� S� �T ICE ELMA 3Sd 48Z 5269 F�CT,d00
,R `
Building,Ptanniny Envrranmentai Health Community Health: FAX 30-427 7798
Aiap iCa on fior Determinat on ofi Se ver Adequacy
Instructions-
3 1 Complete Part,1 ofapp ication. Permit number may b,"4ed at Eater date;"
i
2 fake-'applicat on,Site;pian,and any other associated inforrnatronwith the pre posed:developmeibt to lheSev✓er.
System Manager or Designated Eniployee For approval.,
3 5ubmit completed application and information to Permit Center or Mason Gt ritf.Public Health: or reuiew
":N137E You mustisupply.the System Manager,wiih a site'plan for,the protect,showing ail existing or proposed"
..
sewer components and lines fn..relatton:fo proposed developmetif and property:_
Part 1 Applicant]Parcel information
Applicant: Sam:Martin,.Agerf for Lenriar Northwest,.Inc; Date:- 8/11/2023
tnailingAdd�ess:. 33455 6th Aye S,Unit 1-B City;State 7rp. Federal Way;WA,98003
Slti?:Addres5;'_ 300NEOIymtifcRidQe 'Phone. {253)294.1322
Parcel Number• tz32s s1=oo>za rlsxizs. Permit.Number. 13L1),!q l —b l
Part Z Sewer System Information
Name ofiSewer System Rdfair
Site Plan atta`clied? ;
;0116cfal u.se only: Sewer...Sysferm,Manager or.•Designated Employee is to;cotnpfete..
R (f Newbonrieatiotr i have teviewedtha appricants:."informaiion and have no.issue§WS Mason dounty P,utilic 6iealth app�otiin9 the corresponding ;
Mason County Pb unit
1{
❑ Ex 5Hng ConnepGon I haveYeviewed;the applicants,information and'have,no issues with Mason County Public Heath approving the
cori`esPondiitg.t4ason;Ooupiy Pentiit: �;
❑ I have reviewed the apptican►s information and have determined se"rconnedian'is currently NOT available.to thispropetty,
t
4
Please add the fb(lowing condittonis)on3he.corresponding Masori County PeriniC(optional/.
Must meet ail Mason County design and conStru.dfion standards, must pay All fees
t
includin":co ,. ection fee:with permit'and inspection fee;and Latecomers•char a 6D).
Richard Dickinson_., .. 8/15123
Printed Nameor System Manager/Employee -Signature oCSystem Manager/Emptoyee` Date
Part 3;Mason:.County'Public Health Review]Approval
Satisfactory Q Unsatisfactory
?` Signature of Envirgnrnenta!'NealthSpecialist Date
This form may be scanned and available for public view on the Masan County Web Site.
RN35ED 3?I2021
4