HomeMy WebLinkAboutcom2014-00125 - COM CD Environmental Health Review - 8/27/2014 E- i� Yl11no�_.
COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW
Mason County Public Health Official use only
415 N.6th Street Permit Number: rAW u ij•�1 e�
15
PO Box 1666
Shelton,WA 98584 Date Received: a-Z.7-7_ol,4
Shelton: (360)427.9670.Ext.400 Amount Received
Belfair: (360)275-4467 Ext.400
Elms: (360)482-5269 Ext.400 Receipt Number
Fax (360)427-7787
Applicant Information '' /1,�( Type ojReview
Applicant WirtNtttY Date Building Permit
Mailing Addresst,c w. CT
Cl New 0 Replacement
c K< 1 +ZN1 wYi Cf 8S-,g O Commercial Building Permit
Ciry
State yip 0 New 0 Replacement
O Building/Commercial PermitRevision
Daytime Phone Other Phone Tenant Review-jh+"d re..oil IT
E-MailAddress�- ^ u.C6+.—(5.3 %l•Gar" 0 Pre-Application
Parcel Information rt-n6A_
12-Digit Parcel Number ''^' _ L14 n b O 1
Site Address l- -ter'-%J . I— Ct7+lf�
Sled NumM .Sven Name rn
Type of Job Please submit a scaled plot plan
showing all existing and proposed
Describe work TZ building, on-site sewage system,
Number of Bedrooms�_ and well.
On-Site Sewage Information Water System Information
E On-Site Septic System O New ®-Existing Plumbing in structure? H Yes l7 No
00 n
0 Sewer Name of Sewer System If yes: (rAnoe c epowe - troy"
ooLq
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. /,1JG0 tot q -
for both of these requirements may be on file with Mason
County Public Health. Other requirements may apply. 000/&
Appli ure .r
Date
Official use only OCT 01 2014
Departmental Review A roved 9aRIe Notes
Water Adequacy
On-site Sewage System
Tenant Review U Fn 201 - 0040 3
Revision