HomeMy WebLinkAboutBLD2023-01136 - BLD CD Environmental Health Review - 10/24/2023 MASON COUNTY �g� � L 2 • �` �`+
COMMUNITY DEVELOPMENT SEF 1 1 202 PertnR AsslsGn<e CenceG OUIMIDL Pbnning
BUILDING PERMIT APPLICAM61SI✓V. Alder Ir k
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: F/Lti o13
NAME: 1 d 5 111] NAME:--
MAI,IJGAD RESS: .MAILI1GADDRESS:IMI---gE
CITY: ion 'STArE: ZN: C1TY:Parmaw STATE:— ZIP: O
PHONEgI:_�A¢_717 -h2Z • PHONE:�M M CELL: n Z
PHONE k2: - o EMAIL:hwmwrO Nnwr—
EMAIL: L&I REGNAOAIa m EXP.qt )w /M
- = m
PRIMARY CONTACT: wNEap WNfIUICfoa❑ Ra❑ y Z
NAME - EMAILt
',MMudcADDRess�gT._uL,_N_AE„p an_�e1[1nsrnrezrr� D
PHONE _ 7 T-711 -72 y5 CELL ^ r
PARCEL INFORMATION:
PARCELNUMBER(12 Digit Number) 52 51t*t`tl ZONING
LEGALDESCRB'TION(Abbmmtul) Tw hlp2MNagagsWg 47n IASgOM81NIM1]gft"I M&Plew.
STrEADDRESS210 W.NNwatrMBntli Dr.s .WA �'TYSlwlbn
DIRECTIONS TO SITE ADDRESS
t-- ISTHEPRQIECTWITRBi300FTOFSLOPE(S)CREATERTRANII%: YE50 NO SNOWLOADLW,�
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: lehereart Nmoppry):
SALTWATER D LAKE D RNEWCREEK D POND D WETLAND D SEASONAL RUNOFF STREAM[]
TYPE OF WORK: NEW O ADDITION❑ ALTERATION❑ REPAIR[] OrNER D
USE OF STRICTURE(Aeztlwav,eanrge,u.mo Xds.Pie)F
ISUSE: PRIMARYEI SEASONALD NUMBER OF BEDROOMS S NUMBE,OFBATHROOM,2
HEATED STRUCTURE? YES rFha'aFIh1 Q YES?orUN yFNg1❑ NO❑
DESCRBIEWORK�Matntpgresiewce w MWIw.wNrt—bYM
SQUARE FOOTAGE:
ISTFLOOR1a0 p.& ZKDFLOORMI p.& 3RDFLOOR p.R. BASEMENTp.ft
DECK aq.R COVEREDDECK p.R STORAGE K.0. OTHER N.a.
GARAGE p.O.AN.W[] De.ch CARPORT p.0. A0aehM❑ DeGdm []
MANUFACTURED HOME INFORMATION: e0 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEPTICO SEWBR❑ / NEW❑ EXISTING El
PLUMBO1GOl STRUCTURE? YFSQ NO[] lf)' ,.O hrow kfe Ware,Adequ.ry Form
PRIUMETEKTOUNDATION DRAINS PROPOSED? YESEI NOD EXISTINGS%FT.
EXISTMG BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS
OTHER acMwMaEpes MNaudnieabn dMesureb inknnetlon my reeulr In a Yopzmrk oNn w perlrYr 2vocetlon.NknpAe[IpeTeN MeoT k Oy
slPnarure Cab-.I Eetlere IM1eI l en Ne ormer.M I IuaMr Eecbre Net I en antltleE b recelro NIs permH enE to OotM-M1 az prcpsed I Me
.,.npa^bz:ion M1om.n No nemasery petliv.iMadrg anv oasanam Igtler n parties w IMerssl rawrairq wiz pgeol me ovmn w leptl
repreazw lw
re(,rfumoewand IM IM n.TnponEeaplica l aMpanb D&P dezal Mara Lwnlya bNaa Mz prapeM
eM abucWra(s)M reWaw anE inzpecCon.TM1ia pwmbapplica�bavvnea nW 8 vuE Hwk orauYor4W cons4uGm 4 M cannwrceE w1Mn 180
Leta wHc.nsWc4an w.M 4 auapenEeE fora periM of 100 tlays.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS
PERMIT APPUCATHN OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUM CODE 14.00A21
11 -&Z7t
Sgna WOWNER(MUM ba M.M I4e OWNER) De
DEPARTMENTAL REVIEW APPROVED DATE DEMED DATE 'TAGSINOTEWCONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MAR4 •y"'
PUBLIC HEALTH I tr I yw5
EH Setbacks r
A.) DininfielNReserve requires 10'setback from footing/foundations
B.)Septic tands)requirea 5'selbsck from all footinglfoundations 4-
C.)No foundation/Perimeter Draina wahin 301t,dow igradient of e
DreinfielNReserve area
D)No Cut Banks)(greater than 5h and over 45 degrees)within
5011,down gradient of Drainhed/Reserve area
�OJ4L�
L O wool A,
C
V t
EH APPROVED
Rhonda Thompson 01/28/2025 %
N
ry!i iP
C s` f'
Idl 10 min
1k
, rA t 'a
F �Y
t t
1. &
1 i