HomeMy WebLinkAboutSPI2024-00100 - SPI Application - 9/27/2024 M ASON COUNTY sPi2� - DvloU
COMMUNITY SERVICES 1
Building.Planning,Environmental Health Community Health PLANNER
615 W.Alder St.-Bldg.8,Shelton,WA 98584
Phone:(360)427-9670 ext.352♦Fax:(360)427-7798
PLEASE PRINT $300.00 FEE REQUIRED
PLANNING DEPT. PRE-INSPECTION APPLICATION
Note:Pre-inspection does not survey lot lines and can only provide very general septic and water adequacy information.
1 PO-("Ow-ner: 5(�`r<-��.L Applicant: i O -4 6 kn gyp✓►
Site Address: a A52 E A- D rz t ✓6- Applic nt Address: / 9.6w � t, no�,LUN UN A✓E_
Owner Address: Z7 2- City: Q St Zip ,cR
City: B6L-F'r4►oe_ StJI- Zip 98 S'Z8 Phone:(3(po ) %5 Z�- -ci 2G�j/ day
Phone: ZT-) C,2 3 Gl l ce Co Email Address: Van/�%pMtl5( h .�c kt rt Lie.67-7 •�e'"�
Email: yItA 2 2oZ 0— WAi.4t.L._ ,eoLAA
(if different than applic t) Legal Description:
2. Parcel No./Z Z o S - Do o$p
Parcel No. - -
3. Purpose of Pre-Inspection_ kJ F y,.4 N� �F�'EX&,J ,A 4 11 o
At?Pat A, Ill iN \ 'T t'�t_,— ZozH P /tact Owl
4. Use of building:
5. Do any of the following exist on or adjacent to property?: slope saltwater lake( river
pond( ) wetland seasonal runoff( other stream seasonal creek
Directions to Site:
If the information is incomplete, then Mason County must disclaim any errors resulting from deficiencies in the original
application. Pre-inspection reports remain valid only until development changes occur in the vicinity which affect the lot
evaluated in this inspection,or the laws gulating development of the site change after the time of inspection.
Applicant Signature: Date: -Z;-Z y
If you would like to he on site during inspection,please the Uic ,
Return application to: Mason County Community Selanning Division
615 W.Alder Street
Shelton, WA 98584
(360)427-9670 ext.352
Please include a $300.00 check or money order payable to Mason County Treasurer
When completed,this form becomes part of the parcel file.
• FOR OFFICE USE ONLY:Accepted by: A-Vi f Date:
MORE ON BACK SIDE
Rev. April 2021
Aff �
Please illustrate below the proposed building site in relation to critical areas (slopes, streams, lakes, wetlands, etc.)
existing improvements, as well as property lines. APPLICATIONS SUBMITTED WITHOUT ADEOUATE
ILUSTRATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED TO THE APPLICANT.
Departmental Review
(For Office Use Only)
Planning Department Findings:
Mason County WA GIS Web Map
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9/27/2024, 2:53:09 PM 1:1,530
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L...1 County Boundary ��i��
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• Site Address(Zoom in to 1:3,000)
❑ Tax Parcels(Zoom in to 1:30,000) Esri, HERE, Garmin, (c) OpenStreetMap contributors, and the GIS user
community, Source: Esri, Maxar, Earthstar Geographics, and the GIS User
Contours 5 ft Community
Mason County WA GIS Web Map Application
Mason County disclaims accuracy,reliability,or timeliness of website info,not liable for losses from reliance on it.https://www.masoncountywa.gov/disclaimer.php