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HomeMy WebLinkAboutBLD8354 Mobile Home - BLD Permit / Conditions - 8/19/1975 Tracy, Leo #8354 8-19-75 NIP, SE!, NEµ, SW4, 5-20-2 (Buck Lake Campsites) Mobile Home BUILDING PERMIT APPLICATION MASON COUNTY P. O. Box 400 Shelton, Washinqton 98584 DATE ISSUED �'��' 7--5 _ PERMIT NO. ----T_ —_- MAIL ADDRESS ---_—_ _ ---21P PNONL -- -- OWNER _ / L _� 6 SioS n��cT �+���—Lt �9 f`S DIRECTIONS TO JOB SITE LE MAIL ADDRESS 21P GAL � (❑ E fcE ATTACHED fHETI R. D. .-— © F_ ac t_�E T �S W�-- — — MAIL ADDRESS PHONE CONTRACTOR USE OF MAIL ADDRESS PHONE LICENSE NO. BUILDING Class of work: ❑ NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE O REMOVE Describe work: Valuation of work: $ / cc C) ot� PLAN CHECK FEE PERMIT FEE_,�(I t4 SPECIAL CONDITIONS: p APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOP,ISSUANCE BY / Type of w Occupancy Const. /—� Group Division GC L� G(� ,{7C✓ LJ Size of Bldg. No.of � Max. (Total)Sq. Ft. Stories Occ. Load CONTRACTOR AFFIDAVIT Special Approval$ Required Received Not Require I Certify that I am a currently registered contractor in the State ZONINCI of Washington and the County of Mason and i am aware cf the HEALTH DEPT. ordinance requirements regulating the wcik fcr which the permit P0190c WORKS Is Issued and all work done wi:i be in conformance therewith. 045A15 5gii5r. Firm By — Lic. No. Date OWNERS AFFIDAVIT I certify that I am exempt from the requirements of the contract. or registration law RCW 18.27, and am aware of the Mason N 0 T I C E County ordinance requirements for which this permit is issued and that all work done wil! be in conformance therewith. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF Owner 46_- Date _ 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH ✓ SHEL.TON PRINTING CO. PARCEL NO. THURSTON-MASON HEALTH DISTRICT DATE BASIS FOR FEE AMOUNT Nu CEI BEI< DIVISION OF ENVIRONMENTAL HEALTH 529 WEST FOURTH 110 W.K ST P.O.BOX 746 PHONE 753-8073 PHONE 426-4407 OLYMPIA, WA 98501 SHELTON, WA 98584 OWNER P.O PHONE DIRECTIONS TO SITE: TOTAL FEES 7 y SEWAGE CONTRACTOR ADDRESS OR LOCATION i v NAME OF PLAT / ` d!' LOT NO. SOIL TYPE TOWNSHIP O �/ RANGE -2 GtJ SEC. DEPTH TO WATER TABLE _ FT. WATER ❑PUBLIC ❑ PRIVATE SOURCE PERC. TESTS: INCHES PER HOUR r TYPE OF LOT BY: DATE BUILDING BASEMENT SIZE X NO.OF NO,OF GARBAGE PRIMARY SECONDARY BEDROOMS BATHS DISPOSAL SEPTIC TANK IS1 GAL, AERATION GAL. SPACE RESERVED FOR DISTRIBUTION TILE TOTAL FEET REPLACEMENTS DISTRIBUTION FIELD SO FT NORTH - SITE PLAN AND SPECIAL STIPULATIONS: TRENCH BOTTOM AREA SQ. FEET QUANTITY OF APPROVED STONE CU- YD. SAND CU. YD. FILL REQUIRED CU. YDS. THE ELEVATION OF THE BUILDING SEWER SHALL BE SUCH THAT THE MAXIMUM DEPTH OF THE DISTRIBUTION TILE SHALL BE BE- TWEEN 12 INCHES AND 36 INCHES FROM FINISHED GRADE TO TOP OF TILE UNLESS OTHERWISE STIPULATED BY THE HEALTH OFFICER. IF THE ELEVATION OF THE BUILDING SEWER IS TOO LOW TO MEET THESE ELEVATIONS, A SEWAGE EJECTOR MAY BE REQUIRED. P. ISOLATION STANDARDS FOR PRIVATE WATER SUPPLIES: BETWEEN WELL AND TANK OR ANY PART OF THE TILE FIELD, 100 FEET FOR SINGLE RESIDENCE, MOBILE HOMES, DUPLEXES L/ AND MULTIPLE DWELLINGS. NO DRAINFIELD WITHIN 100 FEET OF ANY WELL, FRESH WATER LAKE OR STREAM)00 FEET FROM ANY SALTWATER BODY. NOTE FOOTING DRAINAGE, DOWNSPOUTS, WATER SOFTENER AND ANY OTHER WASTE WATER NOT DEFINED AS SEWAGE SHALL NOT BE CONNECTED TO OR DISCHARGED INTO THE SEPTIC TANK SYSTEM OR THE SEWAGE DISPOSAL AREA . ALL SEWAGE, INCLUDING SINK AND LAUNDRY WASTE, MUST BE CONNECTED TO THE SEPTIC TANK. FINAL INSPECTION REQUIRED BEFORE BACKFILLING OFFICE USE ONLY TO BE BACKFILLED AFTER INSPECTION DATE APPLICANT MUST CALL FOR INSPECTIONS LISTED BELOWNOT SITE: ❑ APPROVED ❑ APPROVED (i 2" STRAW BY: �� STONE NOT O OVER TILE SEWAGE: ❑ APPROVED ❑ APPROVED BY STONE WATER: ❑ APPROVED ❑ NOT BY: - UNDER TILE APPROVED E CROSS SECTION OF TRENCH OO M�