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HomeMy WebLinkAboutBLD4511 Mobile Home - BLD Permit / Conditions - 5/2/1979 Skipworth, William H. #4511 5-2-79 NW 1/4 NW 1/4 32-21-3 (Portion) Route 5, Box 582D, Shelton Mobile Home i BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED — ,7- 7 PERMIT NO. S/ OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE DIRECTIONS TO JOB SITE LEGAL ,t (❑SEE ATTACHED SHEET) DESCR. /V w �/q N IA)1/ 3g—.� /_3 NAME I MAIL ADDRESS CITY 3 STATE jJ ,�yICENSE NO. PHONE CONTRACTOR R���, h OGC� 'NlA e c)m e� 3 1 0 0 V m i C // /V 1 G l !j L12 7 V USE OF BUILDING do YR e Class of work: X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: e- a+e r - S e �rlq7q. Valuation of work: PLAN CHECK FEE PERMIT FEE SPECIAL CONDITION Sr: BEDROOMS DECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SO. FT. GARAGE ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING. TOTAL SQ. FT.1W FIREPLACE ❑ DETACHED ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER I certify that I am a currently registered contractor in WORK IS COMMENCED. the State of Washington and I the aware of the FOR OFFICE USE ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in conformance therewith. PERMANENT A, SHORELINES ❑ SEASONAL ❑ FLOODPLAIN ❑ Firm E.D. NO. S.E.P.A. By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS certify that I am exempt from the requirements of the FIRE MARSHAL contract or registration law RCW 18.27, and am aware BUILDING DEPT. of the Mason County ordinance requirements for which this permit is issued and that all work done will ROAD ACCESS be in conformance therewith. MOTOR VEHICLE PERMIT (�► i APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUA Own r � Date. ' 4 Y PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. t o-62136 DESCRIPTION : That portion of the Northwest quarter of the Northwest quarter of Section 32 , Township 21 North, Range 3 West , W.M. , in Mason County, Washington , described as follows : BEGINNING at the Southeast corner of said subdivision ; thence North 89° 54 ' 16" West along the South line of said subdivision 680 feet, more or less, to the Southeast corner of that certain tract of land conveved to Clinton R. Willour and Dortha E. Willour , husband and wife by instrument recorded May 22 , 1975, under Auditor ' s File No. 300476 ; thence North 021 27 ' 38" West 100. 93 feet; thence North 490 36 ' loll West 243 . 99 feet, more or less , to the Southeast corner of that certain tract of land conveyed to Edward Scott Bishop and Trina Marie Bishop, husband and wife by deed recorded October 6 , 1975 , under Auditor 's File No. 307099 : thence North 370 33 ' 37" East 460 feet, more or less , to the center line of Johns Creek ; thence Following the center line of said Johns Creek in a Southeasterly direction to its intersection with the East line of said Northwest quarter of the Northwest quarter; thence South 10 04 ' 33" East along the East line of said subdivision to the Southeast corner thereof and the TRUE POINT OF BEGINNING. EXCEPT that portion thereof conveyed to Mason County, Washington for , road purposes by deed recorded May 22 , 1975 , under Auditor ' s File No . 300471 . SI?E.NC3. r795 Z d t�-'/`_`'�-PARCEL NO. THURSTON-MASON HEALTH DISTRICT DATE BASIS FOR FEE AMOUNT NUMBER DIVISION OF ENVIRONMENTAL HEALTH y 529 WEST FOURTH 110 W.K ST P.O.BOX 746 PHONE 753-8073 PHONE 426-4407 OLYMPIA, WA 98501 SHELTON, WA 98584 APPLICA T _ I ! 0 =! ADDRESS PHONE DATE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOW SITE: APPROVED ❑ NOT APPROVED SEWAGEa, CONTRACTOR BY:it � r NAME OF PLAT LOT NOT NO. SEWAGE: ❑ APPROVED ❑ APPROVED SEC. TOWNSHIP RANGE BY: DESIGNER: TYPE OF NO.OF -� LOT 6 /S1c(i SOIL TYPE G Fzl1 yz BUILDING Mp 1�BEDROOMS �i SIZE X WATER GARBAGE DEPTH TO WATER TABLE FT. SYSTEM PR( Vl1(C_ DISPOSAL PERC TESTS INCHES PER HOUR - LIQUID WASTE G.P.D. BY DATE PRIMARY NORTH - SITE PLAN AND SPECIAL STIPULATIONS: SEPTIC TANKS) /_2 0 y GAL. PUMP REQ. ND (INDICATE DIRECTION OF DRAINAGE) (�! DISTRIBUTION TILE TOTAL— FEET FILTRATION AREA 3 SQ. FEET QUANTITY OF A C R 5 APPROVED STONE CU. YD. SAND CU. YD. O FILL REQUIRED CU. YDS. C SPECIAL SYSTEM REQUIRED VC' s THE ELEVATION OF THE BUIrDING SEWER SHALL BE SUCH THAT � ) THE MAXIMUM DEPTH OF THE DISTRIBUTION TILE SHALL BE BE- TWEEN 12 INCHES AND 36 INCHES FROM FINISHED GRADE TO TOP OF TILE UNLESS OTHERWISE STIPULATED BY THE HEALTH �y OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO LOW TO MEET THESE ELEVATIONS, A SEWAGE EJECTOR MAY BE REQUIRED. ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES: ' BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD, 100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET OF ANY WELL, FRESH WATER LAKE OR STREAM; 100 FEET FROM 4j 1 ANY SALT WATER BODY. NOTE: ''FOOTING DRAINAGE, DOWNSPOUTS, WATER SOFTENER AND ANY /D OTHER WASTE WATER NOT DEFINED AS SEWAGE SHALL NOT BE CONNECTED TO OR DISCHARGED INTO THE SEPTIC TANK SYSTEM OR THE SEWAGE DISPOSAL AREA". ALL SEWAGE, INCLUDING SINK AND LAUNDRY WASTE, MUST BE DIRECTIONS TO SITE: CONNECTED TO THE SEPTIC TANK. m FINAL INSPECTION REQUIRED BEFORE BACKFILLING TO BE BACKFILLED OCT 1 1977 AFTER INSPECTION k� 2" STRAW REGIONAL PLANNING E-r 2---] STONE OOVER TILE `c© STONE UNDER TILE THIS SITE PERMIT EXPIRES I E Rco I CROSS SECTION OF TRENCH �� SITE bfO� t PARCEL NO. RECEIPT THURSTON-MASON HEALTH DISTRICT DATE BASIS FOR FEE AMOUNT NUMBER DIVISION OF ENVIRONMENTAL HEALTH 529 WEST FOURTH 110 W.K ST P.O.BOX 746 PHONE 753-8073 PHONE 426-4407 OLYMPIA, WA 98501 SHELTON, WA 98584 OWNER P.O. PHONE DIRECTIONS TO SITE: TOTAL FEES h r- C1. SEWAGE �fevQ CONTRACTOR U;p a-s 1}714 /) to ed nil ADDRESS OR LOCATION NAME OF PLAT LOT NO. SOIL TYPE TOWNSHIP RANGE SEC. DEPTH TO WATER TABLE FT. WATER ❑ PUBLIC ❑ PRIVATE SOURCE PERC. TESTS: INCHES PER HOUR TYPE OF LOT BY: DATE BUILDING BASEMENT SIZE X NO.OF NO.OF GARBAGE PRIMARY SECONDARY BEDROOMS BATHS DISPOSAL SEPTIC TANK lSl GAL. AERATION GAL. SPACE RESERVED FOR DISTRIBUTION TILE TOTAL FEET REPLACEMENTS DISTRIBUTION FIELD SQ FT. NORTH - SITE PLAN AND SPECIAL STIPULATIONS: TRENCH BOTTOM AREA SQ. FEET QUANTITY OF APPROVED STONE CU. YD. SAND CU. YD. FILL REQUIRED CU. YDS. THE ELEVATION OF THE BUILDING SEWER SHALL BE SUCH THAT L' THE MAXIMUM DEPTH OF THE DISTRIBUTION TILE SHALL BE BE- E TWEEN 12 INCHES AND 36 INCHES FROM FINISHED GRADE TO 'S TOP OF TILE UNLESS OTHERWISE STIPULATED BY THE HEALTH s OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO LOW TO MEET THESE ELEVATIONS,A SEWAGE EJECTOR MAY BE � .. REQUIRED. ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES: BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD, 100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET OF ANY WELL, FRESH WATER LAKE OR STREAM;100 FEET FROM ANY SALT WATER BODY. NOTE: "FOOTING DRAINAGE, DOWNSPOUTS, WATER SOFTENER AND ANY OTHER WASTE WATER NOT DEFINED AS SEWAGE SHALL NOT BE CONNECTED TO OR DISCHARGED INTO THE SEPTIC TANK SYSTEM OR THE SEWAGE DISPOSAL AREA''. ALL SEWAGE, INCLUDING SINK AND LAUNDRY WASTE, MUST BE CONNECTED TO THE SEPTIC TANK. FINAL INSPECTION REQUIRED BEFORE BACKFILLING OFFICE USE ONLY TO BE BACKFILLED AFTER INSPECTION DATE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOW 12" TO 24" SITE: ❑ APPROVED ❑ NOT 2" STRAW APPROVED C� BY: E STONE NOT O OVER TILE SEWAGE: ❑ APPROVED ❑ APPROVED BY: F STONE WATER: ❑ APPROVED ❑ NOT BY. UNDER TILE APPROVED CROSS SECTION OF TRENCH OO M PLOT PLAN ADDRESS /\ �3O�C U S yZ_ y Y A/ L 7 'r PERMIT NO. 4 a = o n s a o LEGAL a DESCRIPTION LOT BLK ADDITION u SITE AREA �' iZ AcR-rsSq.Ft. AREA OF SITE OCCUPIED BY BUILDINGS If Sq. Ft. INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION A'"D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. 0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' o a 4 ``» I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. NAME(S) OF OWNERS) OF SITE Q STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE 6M ELTON PRINTI--