HomeMy WebLinkAboutSPI2024-00098 - SPI Application - 9/19/2024 ! 1
MASON COUNTY sPl 20z� - _0
COMMUNITY SERVICES /��
Building,Planning, m Environental Healtk Community Health P LA N N E R 1q1 vl I Y/�t
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. Owner:Tr64 f' Q4rwn 10-VA Applicant:T my(r5 R""'(G,y L
Site Address: 261y &W ly—, Is Kc few Applicant Address: 1091 If C o%
Owner Address:Sw� City: 'jamfad St Zip y S�
City: 561Joky St kA Zip 4�_ Phone:060 ) 0 Z4,') day
Phone: H( 211 ) '736 24-70 rr,-.h Email Address: pV1-. E �cllg�lcm•st�c��To,,.
Email:Tre-,(.. loA 66 Q 4*%A?(t Co#+,
(if different than applicant) Legal Description:
2. Parcel No. 27 60 - 50 -(W 16
Parcel No. - -
3. Purpose of Pre-Inspection:: 5.,-fl te k / L fir^ )4-e u SF'R
4. Use of building: Afto
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: D re, tv rti, Vi S
L on Qhclli le. Le L 5a,cr1 -I4 7/ �. 1
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 regulating development of the site change after the time of inspection.
Applicant Signature: Date:
If you would like to be onade<ring inspection,please check here:
Return application to: Mason County Community Services,Planning 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: Date:
MORE ON BACK SIDE
Rev. April 2021
f r 1
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: