HomeMy WebLinkAboutBLD2025-00400 - BLD CD Environmental Health Review - 4/1/2025 MASON COUNTY Permit No: �t 400
- , EI VED
COMMUNITY DEVELOPMENT
APR 01 Permit Assistance Center,Building,Planning 2025
BUILDING PERMIT APPLICATION 615 ily,,grS
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
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NAME:Do IA<s \A) I 1/I-6 NAME:
MAILING ADDRESS:70 I ( IMAM OR MAILING ADDRESS:
CITY:.S14PL7oN STATE:WA ZIP: 9 '51$t CITY: STATE: ZIP:
PHONE#1:2 5 3 230- sir 34, PHONE: __ CELL: J
PHONE#2: EMAIL:
EMAIL:DoUVSWiLLiSe 6t ►Ae6. .OM L&I REG# EXP._/_/ Ar,� ' ,:,,,,.
PRIMARY CONTACT: OWNER Qj. CONTRACTOR❑ OTHER Q
'D NAME DO/4 G 4eliL.Lt' ' EMAIL DOLJ ' L.L#'s�6MA aL, RECE/VEO
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION: rr��
PARCEL NUMBER(12 Digit Number) pc e&O Z s 7 6 OUO 2 O ZONING 5 ACRE
LEGAL DESCRIPTION(Abbreviated) TR4C,2 VOL I Pte.2O$ 9 12-75 FIRE DISTRICT tS
SITE ADDRESS 6 , IARAD Rbr CITY
DIRECTIONS TO SITE ADDRESS 60 Sown./ On/ gC, /M4.77r't IS. RD .5Oi47 /; 7Z/ALN R?j//I
ON TAs.4i3 RO, Sri 13 /bo yA4OS I S7' 4,1 RIyilr51be v
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NOM SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NE\`l ADDITION 0 ALTERATION 0 REPAIR 0 OTHER S3 MOI4AP Anil,
USE OF STRUCTURE(Residence,Garage.Commercial Bldg.Etc.) I1?E11/!CP./CC
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS a NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)l YES(Parr[s]of Bldg)❑ NO 0
DESCRIBE WORK ,4(57741.L ,44oDULAQ `'O#VfE Opf 5-/7-z/ E)C,J7 N/ sfflrc. # WELL,
SQUARE FOOTAGE:(proposed)
1ST FLOOR 15I .. sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT , sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE 72vt10 O MODEL 4,S710t-'7' YEAR ?2 2.S LENGTH tjyo
WIDTH 27' BEDROOMS 3 BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC. SEWER 0 / NEW 0 EXISTING
PLUMBING IN STRUCTURE? YES% NO 0 If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOO EXISTING SQ.FT.
EXISTING BEDROOMS O. PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structures)for reviewsand inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or i ionstruction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT 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 14.08.42)
X ,s:Ge/ 3-Z/-Z S'
Signature OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL /�
PUBLIC HEALTH //� ;Old andbat Oddee6
E
E RR5 STANDARD SETBACKS*
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To
o f Disclaimer Front:25'
02) m a l Mason County does not require surveys for building.As a _ i > NI
o Sides:20'
0 ( 2 � „ I result,site plans may not reflect accurate data. It is the applicant's responsibility to comply with setback requirements. Rear: 20'
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N 8 . *unless otherwise stated on the site plan
Q 'Si, ` / *all setbacks measured from the farthest
Q o c c I \ri -no projection of the building
Z U iJ h .__-. *subject to EH setbacks
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EH SETBACKS RECEIVED
A)Drainfield/Reserve requires 10'setback from footing/foundations 2025
B)Septic tank(s)requires 5'setback from all footing/foundations APR 0
C)No foundation/perimeter drains within 30'down-gradient of drainfield/
EH APPROVED reserve area t
�. osoirzozs D)No cut(s),bank(s)(greater than 5'&over 45 degrees)within 50' 615 W.Alder`Sty
- down-gradient of drainfield/reserve area
E)Sewer transport line may only be within 10'of a water supply line if
approved by the local health officer and the line is constructed IAW section
C1-9 of the DoE"Criteria For Sewage Works Design".
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