HomeMy WebLinkAboutBLD2016-00008 - BLD CD Environmental Health Review - 1/5/2016 MASON COUNTY PUBLIC HEALTH OFFICIAL USE ONLY
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ENVIRONMENTAL HEALTH REVIEW
415 N.6th Street PO Box 1666 Shelton,WA98594 aZ0_..I�a LRJ
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1.Applicant/Property Information
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2.Type of R wevle /Jot, l3.Job/SIN Information
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Pesidential ❑ m Comercial ❑Tennant Review
❑ Neweplacemen[ ❑Pre-Application + =
❑ Remodel ❑ Adtlhion ❑Other("plain below) aeaaw„., .r
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4.On-Site Sewage System/Sewer Information
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ItZO,Site Septic System �1 New ❑ Existing
❑ Sewer n New ❑ Existing
S.Water Sourcelnformation
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Uaig meW0n,,onsiu septic system M11 require a mment maimemoce report Please submit a completed Water Adequacy Form.
ada aecora wand,Wtuno.Docemeao ru,born aimese regdrements may An incomplete submitted Water Adequacy Form may be
be on file avnh Mamncaunly PUNk Heahh.Dtherrequiremmts mayappir returned,and hold up review process.
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A sued she Plan Is required each all FamiW,axmpt Interior remodels.An inwmplate submitted site plan may be returned,and
hold up review process. Paper site for site plan can be 8.Sx11.8.Sx14,or 11 x17(max). Please use checklist below:
❑Propertylines/dlmenslons ❑Primary Dreinfield area ❑Reserve Dalnfieldarea ❑Existing/proposed wells ❑Waterlines
❑SepticTanksloation ❑Location of curtain/perimeter drains ❑Directionof Slope ElDdveways/Parkingareas/Easements
❑Existing Stmcmres/buildings ❑Proposed StrutturesBulldings OSewerlines/tanks ❑Addhions ❑North Amow E]Scale Bar
Applicant SlgnMun Pat Date
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Departmental Review Approval Ends. Date Notes,Conditions,Related Permits
Water Adequacy
Sewer/Septic System
Tenant Review
Revision
THIS FORM MAYBE SCANNED AND AVAILABLE FOR PUBUCVIEW ONTHE MASON CDUNTYWEBSITE Rri,eer/WA115