HomeMy WebLinkAboutSPI2019-00104 - SPI Application - 8/22/2019 �ti1�M�� mdy6
MASON COUNTY RECEIVED
COMMUNITY SERVICES AUG 2 2 2019
Building,Planning,Environmental Health,Community Health
615 W.Alder St.—Bldg.8,Shelton,Wa 98584 615 W. Alder Sfxiwi
Phone:(360)427-9670 ext.352♦Fax:(360)427-7798
PLEASE PRINT $300.00 FEE REQUIRED
PLANNING DEPT. PRE-INSPECTION APPLICATION
1. Owner: Applicant.
Site Address: Applicant A dress: 1
Owner Address: 2. City: Y-) St Zip
City: t Zip 2. Ph ne:( 75zib day
Phone: — day Email:
Phone:() — evening
Planner:
SNIP Comp.Plan Type of Use
2 G Water Body
2. Parcel No.
Parcel No.
Legal Description: h\�l.0
3. Pu ose of Pr +
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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
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Direction to Site: ht
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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 Sign ture: Al ` `Cx� Date:
If you would like to be on site during 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.August 2017
Exhibit"A"
Lot 2 of Short Plat No. 2977,recorded June 2, 2005, under Auditor's File No. 1838949 and being
a portion of the East half of the Southwest quarter of the Northwest quarter of Section 32,
Township 21 North, Range 3 West, W.M., excepting therefrom right-of-way for Jensen Road,
County Road No. 51930;
SUBJECT TO easements, reservations, covenants, conditions and
Restrictions of record;
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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
ADEQUATE ILUSTRATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED TO THE
APPLICANT.
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Departmental Review
(For Office Use Only)
Planning Department Findings: l Lr�
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792 E Jensen
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Sheltonf WA 98584
lot: 5.11 acres I Residential Lots & Land - mLs 1a44639 Courtesy of Shelton Lond & Homes, LLC
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MW 94 W WA
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