HomeMy WebLinkAboutcom2014-00086 - COM CD Environmental Health Review - 6/23/2014 ENVIRONMENTAL HEALTH REVIEW FOR COMMUNITY DEVELOPMENT
Mason County Public Health Official use only
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415 N. 6th Street Permit Number:
PO Box 1666 '3
Shelton,WA 9B5B4 Date Received: n.-13-
Shelton: (360)427-9670, Ext.400 Amount Received `0o. 00
67 Ext.400
Elmer(3 0))4 25569 Ext.400 Receipt Number 4;S)O L' ✓J-1
Fax (360)427-7787
Applicant Information Type of Review
Applicant $. Dat� Building Permit (commercial or residential)
Mailing Addres?2@007A' lrJ O New 0 Replacement
P Z 0Remodel 0ptgsr'7"I'ED
77 iw�� State Zip 0 Tenant Review
t75y�RAi e'P45 -�510 Other Phone 0 Pre-Application JUN 2 3 2014
E-Mail Address— CIA"c S 4Z6 VV. CLDAR ST.
Parcel Information TTrA%" 4'vnp I I
12-Digit Parcel Numbe (emu 5
Site Address L '
Street Number Street Name city—
Type of Job Please submit a scaled plot plan
Describe work? P_M±A _Q� h PJ`v,vS�V- showing all existing and proposed
building, on-sitQ sewage system,
Existing Bedrooms�_ Proposed Bedroom_ and well. Max Size 11"x17".
On-Site Sewage Information Water System Information
On-Site Septic System New O Existing Plumbing in structure? A Yes 0 No
0 Sewer Name of Sewer System If yes:
- _ Using an existing on-site septic system will require a current Please submit a completed Water
maintenance report and a Record Drawing (Asbuilt). Documents Adequacy Form.
for both of these requirements may be on file with Mason
County Public Health. Other requirements may apply.
Applica, e Afj1•fAo\]E
Ar LIC HEALTH pate �!, 01
ISF M A E SCANNED ILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WESSITE
AL fficial use only
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Wa#ntal Review Approved Date Notes, Conditions, Related Permit Vs
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Re.sed 111=014