HomeMy WebLinkAboutMIS93-00166 Pre-Inspection - MIS Application - 4/29/1993 MIS
MASON COUNTY
Y
MAY 101y�') PRE-INSPECTION APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584. 427-9670 �\
' F $25.00 Fee Required.prior to inspection
Pu i�AL SERVICE._
#1 Owner ov i Phone#
Site Address fi r City
Mail Address S _
City St Zip
Applicant �r&V Phone#
Applicant Address
City ?oc { er)c C St Lie. zip . '2 31�ln
#2 Parcel No. as 3 1 / - 9s- 00 D d O
Legal Description (A F V 0 L 3 ? /I C res 1?4
co"y
#3 Purpose of Pre-Inspection 7�) e J L4 coso 1
#4 Use of building 1 eJ eve
#5 Indicate by circling the applicable source if any water is on or adjacent to subject property:
saltwater lake creek stream marsh rive pond wetland seasonal runoff other
Directions to Site:/ r .rc Jl
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Show following on the site plan below: Lot Dimensions, Existing Structures, Structure Setbacks, Water Lines, Septic Systems,
Flood Zones, Wells, Shorelines, Easements, Name of Flanking & Fronting Streets. Indicate directional by N, S, E, W, etc.
Applicant Signature Date
FOR OFFICIAL USE ONLY: Accepted by:_ Dater
Receipt No. Referred To
DEPARTMENTAL REVIEW
FOR OFFICIAL USE ONLY
Proposal Proposal
Approved Denied
Planning:
AL
Building:
Fire Marshal:
Special Conditions
RANGE 2 TOWNSHIP 23 SECTION II
SCALE 1 " = 400 ' 1 'I
NTAHUYA
RIVER
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