HomeMy WebLinkAboutBLD2025-00196 - BLD CD Environmental Health Review - 2/8/2025 MASON COUNTY PermitNh: T/ICI��% -d���il�
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:C& R`) NO )fitjlej≤w I N.M4E:MMJL. k g.us
MAILING ADDRESS: flU nr0a uA I MAILING ADORES S:7OE awn IQ &4 Ab
CITY:YGUAt S ATE wA ZIP: fl CITYWt*tl. tk STATE(&,,_ZIP: ;
PHONE#1:S0•. LB-DLO/ PHONE:_ _CELL �,
PHONE#2:'O- - •�O M^ o EMAIL:
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EMAIL:
PRIMARY CONTACT: OWNERS CONTRACTOR El OTHER '
NAM P!{�MAILING � OTT STATE(L�_Zf
PHONE jt4l CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number).�n17- i'C003C. ZONING R ^ ? C
LEGAL DESCRIPTION(AbbrcviatW)t34+st i-a. FIRE DISTRICTt `17Qt
SITE ADDRES3IT21 S A.SILt(SC•n •_1 CITY n) FCC/V ✓
DIECUONS TO SITE ADDRESS flZft FQ
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO SNOW LOAD-1QNr
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chick au ua ow ):
SALTWATER❑ LAKE❑ AIVER1CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW(9 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(FmWmne(kAaa Co.m-..+m Bit sa)JP allom£
IS USE: PRI99ARYa SEASONAL NUMBER OF BEDROOMSI NUMBER OF BATHItOOMS. 2
HEATED STRUCTURE? YES(wokBWW l YES(PoMsI detdd 0 NO❑
DESCRIBEWORKNEW CONfl/[LL'%/CJ ? M06lE'C *10(% %
SOUARE FOOTAGE;Gwo+W
1ST PLOOR I3�L W.ft. 2ND FLOOR p ft 3RD FLOOR N FJ eq.8. BASEMENT
DECKN R M.R. COVERED DECK A' sq.ft. STORAGE _ sq.R OTHER_____ ft
OARAGE sq.R Attached fl Detached fl CARPORT Iq.ft Attached 0 Detached
MANUFACTURED ROME INFORMATION: -4 COPIES OF THE FLOOR PLAN REQUIREDMAKE '
C tAQ jyO-J MODELTDHe/NY 6 coo{/YPAR (.STS LENGTH S2
WIDTH 17 BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL AE 1.TH:
SEWAGE/SEWER SOURCE: SEPTIC(y SEWER❑ I NEW EXISTING❑
PLUMBING IN STRUCIIIREx YES NOD 1/yes.attach ycompleted WaserAdegtwryForm
pERIMETERJFOUNDATION DRAWS PROPOSED? YES y EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER adq.o 4etlgee N4ubnlaYon J:naccurt4InlpmI0on may ueutl in a stop work order orpemAtrev aoT.Adno dgement of wd Ia by
Ygnelum below,ldeclare that I em Ne wmer and I NMer daden that I em nosed to receive this pemri and to do me work as prorysel,I have
rtb inM permission M1w rc n all the uuery partly,Indudlrq anyuwnent kidder or pelves Wt Innt regar* Nk{miect The ovmer vIWS
repuanutive,repeamb Mtl Me iMmnNm poNdad is evuule and grants emgayeae of Maun County ereeu 0 Me share tlewidea prcgeay
and pr ticvnWtllon ls wisark le lnspeon. ma
uyerNed faapmlotl 19 ip pr bemnn null a void ft wort nu:lwn W Mn
zeo consctlon Isnd ammenced Mttm
day
PROOF OF CONTINUATION OF WORK ON THIS PERMR IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.09.42)
X �eorOERMU4he Sand by ma OWNER Dale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAG S/NOTE SIC OMIIT'ION9
BUD.DIIG DEPARTMENT
PLANNING DEPARTMENT
FM MARSHAL
PUBLIC HEALTH
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NOT AN APPROVED SEPTIC DESIGN
bJ t Tq J Must use SWG202400403 for septic installation
I - _ - EH APPROVED
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