HomeMy WebLinkAboutBLD14177 Final Mobile Home - BLD Permit / Conditions - 9/20/1983 Plemons, Robert Lee #14177
373-8927 Bremerton 6-17-83
Portion ,SE 4 NE 4 2x$ix2 9-23-2
From Old Belfair Hwy take Dawatto Rd. to Effendahl
Pass and go 12 miles to blacksmith lake division 2
Section 9 Tract 19
Mobile Home
$8,400.00
Shorelines:
Setback:
Special Conditions:
Footing:
Setback:
Foundation Walls:
Framing:
Fireplace:
Wood Stove:
Plumbing:
Mechanical:
Roof:
Exterior :
Interior :
Final:P �o
1 �
Stop Work:
Mobile Home:
Smoke Detector :
Remarks:
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 7
DATE ISSUED
PERMIT NO. /7-/ 7T
OWNER NAME MAIL ADDRESS CITY 8 STAT ZIP PHONE
Ro Wev:t L e Veto P0. F3 o 1< �7 5� !F"e d�f !.J ca, y�31�$ :373 89,J
DIRECTIONS row O�-A Qe% cure HWy. 'f-akk o,W. Otv.aC.-I Pa S S 4L...'4
rTO JOB SITE o /%s /+.•'J-es �� Y31a� S �ti, q � Div+sror" �. -Se�f,b� 9 LEGAL] ••� / (❑ SEE ATTACHED SHEET)
DESCR. •- .3 - C fr C'v ` 1 C 4, .�E y P E
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING 9 LVL+t-
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: n� /
ov e
Valuation of work: $ �) /Oa PLAN CHECK FEE PERMIT FEE
_37SPECIAL CONDITIONS: `T
BEDROOMS DECKS CARPORT L; NOTICE
BATHROOMS TOTAL SO. FT. GARAGE i,'
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIESBASEMENT [] ATTACHED 1 i OR AIR CONDITIONING.
TOTAL SO. FT.� FIREPLACE 1 ] DETACHED 1J
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and 1 the
aware of the FOR OFFICE USE N LY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES I
SEASONAL U FLOODPLAIN I I
Firm E.D. NO. S.E.P.A. 1
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
b ' conform c with. MOTOR VEHICLE PERMIT
r/7-�� APPLICATION ACCEPTED BY PLANS CHECK BY A PROVED FOR ISSUANCE
Owner Date .W
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
nt for "Line Extension Contract and Mortgage" agreement between Robert L
,izabeth J. PlPmons%and Mason County P.U.D. #3.
EXHIBIT A
That portion of the southeast quarter of the northeast quarter
of Section 9 , Township 23 North, Range 2 West , W.M. ,cdescribed
as follows :
COMMENCING at the northwest corner of the southeast quarter of
the northeast quarter of said Section 9 , thence South 02°14 ' 32"
East along the west line of said subdivision 310 . 13 feet to the
True Point of Beginning; thence continuing South 02°14 ' 32" East
along said west line 310. 12 feet; thence South 87°41 ' 23" East
752 . 45 feet; thence North 02°17 ' 38" West 311 . 47 feet; thence
North 87°47 ' 24 " West 752 . 06 feet to the True Point of Beginning;
EXCEPT road rights-of-way. Also known as Tract 19 of Survey
recorded in Volume 7 of Surveys , page 17 , under Auditor ' s File
No. 379318.
TOGETHER WITH and SUBJECT TO a perpetual non-exclusive easement,
60 feet in width, as shown on survey recorded in Volume 7 of
Surveys, page 17 , under Auditor' s File No. 379318 ; and described
in instrument recorded August 6 , 1981 , under Auditor ' s File No.
394035.
TOGETHER WITH a perpetual, non-exclusive easement, 60 feet in width,
over and across the Sa of the SE4 of SE4, Section 3, and the Na of
Section 10, all in Township 23 North, Range 2 West, W.M. , all as
shown on survey recorded in Volume 5 of Surveys, page 138 , under
Auditor' s File No. 368714 and described in instrument recorded
October 26, 1979 , under Auditor ' s File No. 369021.
TOGETHER WITH a perpetual, non-exclusive easement, 60 feet in
width, for road and utility purposes over and across the N31 of the
SE4 of the SE4 of Section 3, and the NEIa of the SE4 of Section
10, all in Township 23 North, Range 2 West, W.M. , as described
in instrument recorded April 5, 1978 , under Auditor ' s File No.
342277. Said easement providing access from the Bear Creek-
- Dewatto County Road No. 7980 to the North line of the Sa of the
SE4 of the SE 4, said Section 3 .
SUBJECT TO utility easement to P .U.D. No. 3 and 'Pacific Northwest
Bell Telephone Co. , Auditor' s File No. 363660.
15 disconnected, the total
bolwnca of the contract, at the option of the District, becomes due
# a • ',:'.� .� _., la�wedlwcoly !a lump num. If only Partial service is utilized, the
7y Yt�� jt+scrd at the option of
And r" ---- the District to rnrrnrr
SITE NO. '
MASON COUNTY HEALTH DEPARTMENT FOR DEPARTMENT USE ONLY
ENVIRONMENTAL HEALTH SECTION PATE BASIS FOR FEE AMOUNT RECEIPT
428 WEST BIRCH STREET • SHELTON, WA. 98584 NUMBER
PHONE (206) 426-5561
APPLICANT SIGNATURE
ADDRESS PHONE NOT
SITE: ❑ APPROVED El NOT
PROPERTY OWNER
BY:
ADDRESS PHONE
DESIGNED SYSTEM REQUIRED
SEWAGE SEWAGE NOT
CONTRACTOR DESIGNER SEWAGE: ❑ APPROVED ❑ APPROVED
LEGAL DESCRIPTION
BY:
SOIL TYPE
TYPE OF NO. OF LOT
BUILDING BEDROOMS SIZE ' X DEPTH TO WATER TABLE PERC. RATE
SINGLE RESIDENCE ❑ PUBLIC WATER WATER SYSTEM SYSTEM ❑ NAME SEPTIC TANK( )S GAL. PUMP REQ.
COMMERCIAL ONLY
LIQUID WASTE G.P.D. DISTRIBUTION TILE TOTAL FEET
DIRECTIONS TO SITE: FILTRATION AREA SQ. FEET
QUANTITY OF
APPROVED STONE-CU. YD. SAND-CU. YD.
FILL REQUIRED CU. YDS.
FINAL INSPECTION REQUIRED BEFORE BACKFILLING
FDEPTH OF
BACKFILL
2T OR PAPER
STONE
PIPE SIZE
STONE
SITE PLAN AND SPECIAL STIPULATIONS I I UNDER TILE
(INDICATE DIRECTION OF DRAINAGE) CROSS SECTION OF TRENCH
COMMENTS:
THIS SITE PERMIT EXPIRES
O
MASON COUNTY HEALTH DEPARTMENT SEWAGE SYSTEM DESIGN
ENVIRONMENTAL HEALTH SECTION DEPTH OF
303 NORTH 4th STREET a SHELTON, WA 98584 r ��BACKFILL
PHONE (206) 426-5561 . 2"STRAW OR PAPER
PROPERTY OWNER DATE SUBMITTED
t L•! I STONE
ADDRESS f ;G• y=�"X �,,j DESIGNED BY 1 OVER TILE
�.7 PIPE SIZE
SOIL LOG— DATA
LEGAL DESCRIPTION Yc� ��STONE
UNDER TILE
✓ to
Rest hctive
` CROSS SECTION OF TRENCH J<-== Layer
CALCULATIONS: GPD if other SHOW THE FOLLOWING ITEMS IN GRID BELOW:
No. Bedrooms than residence A. Horizontal system plan and, if mound system is proposed or
Application Rate:gal./sq.ft./day slopes exceeding 15% provide cross section.
B. Scale
Drainfield Sizing: Absorption Area Ft.2 Total Length Ft. C. Benchmark A , stubout elevation, tank outlet elevation, (bot-
tom of pipe), elevation at finish grade at center of drainfield.
Pump Specifications: High level alarm Elevation Difference Ft. D. Property lines,building,trees,slopes in excess of 5%,driveway.
GPM Discharge Volume E. All wells or drinking water supplies within 100 ft.,water lines.
Volume of sump F. Drainage system detail (i.e.curtain drain).
1
Septic Tank Size and Manufacturer j G. Replacement area.
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NOTARY PUBLIC
I, agree not to hold the Health Department responsible in
the event that the special system as proposed by
fails to operate as required by Articles VI and V11, of the Mason County Health Department Code.
c'
Signature,,A,
Subscribed and sworn before me this day Notary Public for the State of Washington
of 19 residing at
AIM &ASSOCIATES— Olympia,WA
PLOT PLAN
ADDRESS PERMIT NO. f o
n D
LEGAL
DESCRIPTION LOT BLK +ADDITION u
SITE AREA 0.���5 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS / ` Sq. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION Al"D SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
V
4
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.yL
c
T.
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i
i
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(3) OF 31TE 6 STRUCTURE(S) (PRINT) IGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON P"INTIN3