HomeMy WebLinkAboutBLD2016-00009 - BLD CD Environmental Health Review - 1/5/2016 SP�c.E 20�--
MASON COUNTY PUBLIC HEALTH OFFICIAL USE ONLY
COMMUNITY DEVELOPMENT @w -$•apl(o
ENVIRONMENTAL HEALTH REVIEW
415 N4th Street POBoxlW Shehw4 WA9aSB6
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(360)427-9670,&L400 060l2]5s44],r e40p
1.Appilcant/Property Inf
ormation
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2.Type of Review/Job 3.Job/Slb Information
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"Illesidential ❑ Commercial El Tennant Review - •
(LI New ' aaemmment ❑Pre-Application + -
❑ Remodel ❑AddiCan nEo ❑Other(explain below) r.a„n.;a' wem� w
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4.On-She Sewage System/Sewer information
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,&�On-Site Septic system New ❑ Existing W.aewdr""q�o'°°r'aw
❑ Sewer ff New ❑ Existing S.Watersourcelnformation
r.mnwu.esrwaul Plumbing in structure? %Yes ❑ No
awwas.wusyrmamwawbw Ifyes:
unry an edsnip on4tesepiksymmvan reRmreaamentmainhrercercpart Pleasesubmit a completed Water Adequacy Form.
ease Rer«dor,wa�q Umulro.oocumoussarbothofthesemgdieiunts may An incomplete submitted Water Adequacy Form may be
b•on filew Mavoncamty Puekc Hszkh McrryWrmimn[s mayappty. returned,and hold up review process.
She Plan
A scaled Site Plan is required with all permits,except Interior remodels.An Incomplete submitted she plan may be returned,and
holdup review process. Paper size for site plan can be B.SxI1.B.Sx14,or 11x17(max). Please use cheddist belOW:
❑Property lines/dimensions []Primary Drainfield area []Reserve Dalnfieldarea ❑Existing/proposedweils []Waterlines
❑Septic Tankslomtion ❑Locationofcwtain/penmeterdains []DInectionof Slope ElDMevrays/Parkingareas/Fasements
❑Existing Stmctures/buildings (]Proposed Structu
res/Buildings QSewerlinesAanks []Addldons []North Anow []Scale Bar
Applicant Signature A, , �`V® Date
Official use only
Departmental Review Approval antis. Date Nobs,Conditions,Related Permits
Water Adequacy
Sewer/Septic System
Tenant Review
Revision
THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLICWEW ON THE MASON COUNTY WEBSDE au ua 2/wmss
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