HomeMy WebLinkAboutApplication for Waiver Appeal - WAI Health Waiver - 8/21/2003 MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
EnairotmuNd Healfi Water QuaUN iaLh
_ PO UV C tnbo anau.tvra rvt va�aa
LOCAL(360)427-9670
Application for Waiver/ApT�peal B�AIR❑6D)275-4'67 &4468
YP TOLL FREE 1-800-562-5629
FAX(360)427-7798
Amount Paid: 0. J
Receipt,
Instructions
i aif1191"Ilk v�mnteteil
,•:.P e . tlitknv9rb`iSnerat (heci(eddl i
i =�1 .,
1 QR._xp�40 G� t�b1�3'R.VXVW._,
PART 1: Applicant/Parcel Identification
Name of Applicant Julio Fio i Date 8/18Z03
Mailing Address 30330 9th Ave. S. Telephone 2SI-941-6180
Federal Way, Wa 98003
Assessor's Parcel Number 22233 52 00087
Subdivision Name and Lot Madings Sunny Shore Add n6 Tr 87 Ex a-b-c
PART 2: Nature of Waiver/Appeal
❑ on-Site Sewage Requirements ❑ Food Sanitation Requirements
❑ Bui(dingpermi(reviewpa(icier ❑ Solid Waste Requirements
❑ Location, WAC 146-272-09501 El Group B Water System Requirements
❑ Holding rank WAC 246-2 72-12 5 01 ❑ Water Adequacy Requirements
❑ On-Site Standards ❑ Enforcement Timelines
❑ Certification contractor(pumper, ❑ Departmental Determinations l
designer, installer. O&Mapec)requirements ❑ Other
Description of Waiver/Appeal(includejustification,additional material may be attached
19r ` �
The existi house on this property consists of approx sq.ft. wit be demolished
and a new one will be m t wi ap )roxst_s� of only oteinothe
e axis ing ouse a o ptic
,.$aRti s-.—.k4-Nr art f' 1d f f 2 1 6�' rl F pines- .
with reserve for same a 50 from the bulkhead As a precaution, a ilner w so
be added. Design for anew septic system is attached.
A
Applicant Signature: � �0` / Date: �
/L4N
/I:IWDATAIARCH1V61NA1PFRWP Update:April25,1997
PART 3: Health Department Evaluation (Staff Use Onty)
Of Determination Required: I B. Type of On-Site Waiver(if applicable):
1 A. '1YPe ❑Class A ❑Class B ❑Class C
❑ Appeal ❑Waiver ❑None required
2. Identificaton of Specific CoddStandard/Determination(include date of determination or latest
coddatandard revision):
(3t� i a....,q p,t�,.,..1 pa I•
3. Nature of Appeal: c Q l �, n,tw a,.. 2Ov
ayw
£xt7f.-v haw-r� �PZJ��G✓dy� t�
4. Hearing Official:
❑ Health Officer
❑Board of Health ❑Health Services Director
❑Pollution Control Hearing Board ❑Environmental Health Manager[3Certified Contractor Review Board
5 Mitigating Facto Tom, ` � s{ j( wcp,J_ o�.• t•r a�vo++
� r f
/t is complete, and mitigmiwi,.,-,;; ed by s,Me and local
6. /have revie,ved this,vaiver/varianee request.
policy has been submitted.
Staff:
�:� Date: T'11'Fl e —
PART 4: Determination of the Hearing Official
The hearing official has determined that approval of this request will not adversely affect public heaW,and
is herebygranfed. This decision is based on the following findings and conditions:
❑ The hearing official has determined that approval of this request could potentially have an adversely affect
public health and is hereby deffiCd. This decision is based on the following findings:
HearingOolctar
A�z 02?/l./�!� \ Date:
JV.UVDArAWRCfftVE9rAlVERnT Updrte:April 25.1997