HomeMy WebLinkAboutBLD CD Environmental Health Review - 10/16/2015 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW o^h
Mason County Public Health Permit Number:
415 N.6th Street
PO Box 1666
Shelton,WA 96584 Date Received:
Shelton: (360)427-9670, Ext. 400
Belfaic (360)275-4467 Ext.400 Amount Received
Eima7 (360)462-5269 Ext.400 Receipt Number
Fax (360)427-7787
Applicant Information Type of Review
Applicant s2cj T 4 tumJ S-2- Dateto 1 ❑ Buuidin ew ❑
g Pe lt Replacement
Mailing Address 2o t�o.)c \4t=rb
tt1.-�vu985-z4 _ ❑ Commercial Building Permit
O New ❑ Replacement
City State ZiP
❑ Building/Commercial Permit Revision
Daytime Phone 4m-OZ'I Other Phone 3eobot 513h ❑ Tenant Review
E-Mail Address aer_� �ba�m 0 �_ c�^=� ❑ Pre-Application
Parcel Information
12-Digit Parcel Number 11128 32 Roo 30
Site Address 7A-C'f�D st2.may STc 'I 3��s�P� w� 9-JS2.
Street Number Street Name ulty
Type of Job Please submit a scaled plot plan
showing all existing and proposed
Describe work - building, on-site sewage system,
Number of Bedrooms 52!� and well.
On-Site Sewage Information Water System Information
)4-0n-Site Septic System ❑ New KExisting Plumbing in structure? '-Yes ❑ No
❑ 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.
for both of these requirements may be on file with Mason
County Public Health. Other requirements may apply.
Appli i a re
Date
Official use only
Departmental Review Approved Denied Notes
Water Adequacy
On-site Sewage System
Tenant Review
Revision
Revised 12 W99
MASON COUNTY
"DEPARTMENT of HEALTH SERVICES
Shellon.Washington 98584
(206)427-9670• Belfam 275-4467
ENVIflpNMENTAL HEALTH PERSONAL HEALTH WATER OUALIT
P.O. BOX 1666 303 N. FOURTH P.O.ROX 7616
/ MEMORANDUM
DATE:
FROM:
RE: Design for & Parcel ✓�����
Your design for the above referenced parcel has bee/nj reviewed and is
PROVED IX.p CLI A71/'I��
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