Loading...
HomeMy WebLinkAboutBLD2799 Final Mobile Home - BLD Permit / Conditions - 8/6/1979 Connors, Dennis #2799 8-9-78 NE 1/4 NW 1/4 35-21-3 Hwy 3 Mason Lake Road, Mikelsen Road first turnogf (Main gravel on right) Mobile Home 3;) 135 —,;1 o t o � -- I� t 4 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED PERMIT NO. g OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE I ADl C 012 S fo, Be,< UG sFIEcro ca S DIRECTIONS A Aj r 0*o✓i 4 TO JOB SITE 1�iwY 3 - /J�AtdJ M<e- RO 1"ikKf Z,.) RO F/Rsr Tu2,Johi= AF?#z LEGAL 1 (❑ SEE ATTACHED SHEET) 1 DESCR. /L 1/ Oh w� SrC l/O,J S 7'Ot.SiJ5/�//� Z RA C. /H/4SdAJ G-a NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE CONTRACTOR USE OF BUILDING PL/2/1�/A�J.t'�r HOMK �A �RO �r�.J,J Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE Describe work: rroR'offC2 01,JiJ1t w v$ A Iwo l,-0: l d AR Ry 4/L.(- 2 /9 Cl /2 Valuation of work: $ PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: BEDROOMS DECKS CARPORT L I NOTICE BATHROOMS t/ TOTAL SO. FT. GARAGE [I ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATIN . NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING. TOTAL SQ. FT. FIREPLACE ❑ DETACHED [J 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 SHORELINES SEASONAL 1 FLOODPLAIN L; Firm E.D. NO.--- S.E.P.A. I By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS I 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 Kjbei 2pe s issued and that all work done will ROAD ACCESS herewith. MOTOR VEHICLE PERMIT Q ! 7 APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR SSUAN�E Date.V (� c, PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH I I { PLOT PLAN _ADDRESS k)K f��-/ is F cJ /( S1CG 7'/D,J .3S PERMIT NO. 7Zc , S r! z �1 !2AA-j 16IC 3 cJ m4so.J ee LEGAL DESCRIPTION LOT BLK ADDITION SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 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. �n. INDICATE NORTH IN CIRCLE + 5'o GRAPH SQUARES ARE 5' X 5' OR 1"=20' T 200 ' a ,a 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. NAMES) OF OWNER(S) OF SITE Q STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE GHELT ON PRINTIN:v $ITE I40. PARCEL NO. THURSTON-MASON HEALTH DISTRICT DATE BASIS FOR FEE AMOUNT NUMBER DIVISION OF ENVIRONMENTAL HEALTH 2000 LAKERIDGE DR.S.W. FIFTH&BIRCH ST. PHONE 753-8073 PHONE 426-5561 OLYMPIA, WA 98501 SHELTON, WA 98584 APPLICANT ADDRESS PHONE r y DATE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOW j SITE: Q APPROVED ❑ NOT APPROVED SEWAGE CONTRACTOR BY: NAME OF PLAT- LOT NO. SEWAGE: ❑ APPROVED NOT APPROVED SEC. TOWNSHIP RANGE BY: DESIGNER: TYPE OF NO.OF LOT SOIL TYPE BUILDING BEDROOMS SIZE X WATER GARBAGE DEPTH TO WATER TABLE FT. SYSTEM DISPOSAL PERC TESTS INCHES PER HOUR LIQUID WASTE G.P.D. BY DATE PRIMARY NORTH - SITE PLAN AND SPECIAL STIPULATIONS: SEPTIC TANK(S) GAL. PUMP kEQ. (INDICATE DIRECTION OF DRAINAGE) DISTRIBUTION TILE TOTAL FEET FILTRATION AREA SQ. FEET QUANTITY OF APPROVED STONE CU. YD. SAND CU. YD. i / FILL REQUIRED CU. YDS. SPECIAL SYSTEM REQUIRED THE ELEVATION OF THE BUILDING 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 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 DRAINFI5LD 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 DIRECTIONS TO SITE: CONNECTED TO THE SEPTIC TANK. FINAL INSPECTION REQUIRED BEFORE BACKFILLING TO BE BACKFILLED AFTER INSPECTION 12" TO 24" �i 2" STRAW -� STONE OOVER TILE F� STONE UNDER TILE THIS SITE PERMIT EXPIRES I E I CROSS SECTION OF TRENCH ©M