HomeMy WebLinkAboutSPI2025-00001 - SPI Application - 1/3/2024 R Eg1�V
MASON COUNTY - ndb 0 �
COMMUNITY SERVICES JAN 0 3 20Z4
Building,Planning,Environmental Health,Conrnunity Heath P N E R V L.`c
615 W.Alder St.-Bldg.8,Shelton,WA 98594 V 1�7 W�AKW bbVet
Phone:(360)427-9670 ext.352♦Fax:(360)427-7798
PLEASE PRINT $300.00 FEE REQUIRED
PLANNING DEPT. PRE-INSPECTION APPLICATION
Note:Pre-inspection does not survey lot lines and can only provide very general septic and water adequacy information.
o1. Owner: ( ulna✓ Applicant: �Q M
Site Address: A, R, Applicant Address:
Owner Add es City: St Zip
City: St -W4 Zip Phone:(---)— day
Phone:() - Email Address:
Email: Aje m P ,4 .r
(if different than applicant) Legal Description:
2. Parcel No. cS/9�t�- /
Parcel No. - -
3. Purpose of Pre-Inspection: J;w ri
4. Use of building: /i o'2
5. Do any of the following exist on or adjacent to property?: slope VV saltwater( ) lake river
pond( ) wetland seasonal runoff( ) other stream seasonal creek )
Directions to Site:
If the information is incomplete, then Mason County must disclaim any errors resulting from deficiencies in the original
application. Pre-inspection reports remain valid only until development changes occur in the vicinity which affect the lot
evaluated in this inspection, or the laws regulating devel9plRent of the site change after the time of inspection.
Applicant Signature: Date:
tf you would like to be on site during inspection,please check here:
Return application to: Mason County Community Services,Planning Division
615 W.Alder Street
Shelton,WA 98584
(360)427-9670 ext.352
Please include a$300.00 check or money order payable to Mason County Treasurer
When completed,this form becomes part of the parcel file.
FOR OFFICE USE ONLY:Accepted by: Date:
MORE ON BACK SIDE
Rev. April 2021
PW
Please illustrate below the proposed building site in relation to critical areas (slopes, streams, lakes, wetlands, etc.)
existing improvements, as well as property lines. APPLICATIONS SUBMITTED WITHOUT ADEQUATE
ILUSTRATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED TO THE APPLICANT.
3
Departmental Review
(For Office Use Only)
Planning Department Findings: