HomeMy WebLinkAboutCOM2012-00051 - COM CD Environmental Health Review - 4/17/2012 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Official use only CC
415 N.6th Street Permit Number: 01'al CI -��1�
PO Box 1666
Shelton,WA 98584 Date Received: _ 2 C i Z
Shelton: (360)427-9670, Ext.400 t?7
Amount Received
Belfair: (360)275-4467 Ext.400 I G
N
Elma: (360)482-5269 Ext.400 Receipt Number Fax (360)427-7787
t
Applicant Information y�;{rjck.SMt--1"('�- Type of Review
Applicant Sherri Grueneis Date 0 Building Permit
Mailing Address 5209 Lake Washington Blvd. We, suite 200 ❑ New 0 Replacement
Kirkland WA 98033 Commercial Building Permit
city State Zip ❑ New ❑ eplacement
dY
t (425) ez7-uoc 0 BuildinglCoi�a la erml"t�Revision
J + Daytime Phone Other Phone 0 Tenant Review
Y E-Mall Address 9r eneis@fhoarch.com
t 0 Pre-Application
r Parcel Information
�I 12-Digit Parcel Number 12328-23-90002
Site Address 24200 NE STATE ROUTE 3, EELFAIR, WA 98528
Street Number Street Name City
t Type of Job Please submit a scaled plot plan
_ Describe work See attached. showing all existing and proposed
Number of Bedrooms N/A building, on-site sewage system,
and well.
On-Site Sewage Information Water System Information
4 0 On-Site Septic System 0 New 0 Existing Plumbing in structure? 0 Yes 0 No
4-
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 Adequacy Form.
V for both of these requirements may be on file with Mason
U County Public Health. Other requirements may apply.
A rc ant nature
1.7HEJT I tib A464`CT�j rAr i Data
Official use only
-De arbnentalReview Approved Denied Notes
Water Adequacy
On-site Sewage System r
Tenant Review
Revision
ReNs 1WI7109