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HomeMy WebLinkAboutBLD2025-00499 - BLD CD Environmental Health Review - 4/23/2025 • MASON COUNTY Permit No ..9aoa,�'aoq ' COMMUNITY DEVELOPMENT \/ Permit Assistance Center, Building,Planning ? ECE\ v ED BUILDING PERMIT APPLICATION 2 2�2� PROPERTY OWNERINFOR/MATION: CONTRACTOR INFORMATION:APR 2 NAME: \G}. L� r --a- NAME: C. \N (�I(�P.f Stree MAILI AD SS: 6 Zo, MAILING ADDRESS: 9 CITY: • STATE: zIP:9�f t CITY: STATE: ZIP: 7/o� PHONE 1: ' 5 -, 2 5S Z /v / PHONE: CELL: .A PHONE#2: DD � � ),,�_,�n1 / r MAIL: EXP. / / �o cr' EMAIL: g•et7 LA) .0 1' ( tom 6`x�tGl e1 REG# --- <G ,O PRIMARY CONTACT, OWNER CONTRACTOR 0 OTHER❑ �Q �s NAME �( 7- EM7AIL MAILING DRESS STATE �II"�, 11,IENTAL PHONE CELL y� .1 PARCEL INFORMATION: ^^� n Lr LT H PARCEL NUMBER(12 Digit Number) 39065 - -)S 00('0 ZONING LEGAL DESCRIPTION(AbbreviatedL I^� r FIRE D STRI SITE ADDRESS 91 E /I rrk Y"�/ '�-- t y(. l CITY s� 47YL DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO1SNOW LOAD: psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF'❑ STREAM❑ TYPE OF WORK: NEW ADDITION❑ ALTERATION❑ REPAIR 0 OTHER 0 USE OF STRUCTURE(Residence. arage,Commercial Bldg,Etc.) IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 7i HEATED STRUCTURE? YES(N hole Bldg)❑ YES(Part(sI of Bldg)0 NO❑ DESCRIBE WORK SQUARE FOOTAGE:(proposed) 1ST FLOOR 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❑ Detached 0 CARPORT sq.ft. Attached 0 Detached 0 4 MANUFACTURED HOME INFORMATION: *4 COPIE O �IE FLOOR PLAN REQUIRED* MAKE OA� ��, MODEL 9�'eav� r(, AR aaa�LENGTH 4 Lk WIDTH a:1 BEDROOMS 410 BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTICX SEWER 0 / NEW EXISTING 0 PLUMBING IN STRUCTURE? YES ] NO 0 If yes,attac 'ccompleted Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. . EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS 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 structure(s)for review and inspection. This permit/application becomes null&void it work or authorized construction is not commenced within 180 days or if construction 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 APP OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION T BE EXPIRED.(MASON COUNTY CODE 14.08.42) � X 6 ature of OWNER(Must be signed by the OWNER) ate EPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL _ ` ^Qp J PUBLIC HEALTH 1 Z J �� ��� '' w�� `���C r • ----- 61)0209.5—bOWT EH Setbacks EH APPROVED • A.)DrainfielwReserve requires 10'setback from foothglcundatons i B.)Septictank(c)requires 5 setback from all looting/foundations Rhonda Thompson 05;08/2025 C.)No foundation.Perimeter Drains within 30ft,downgradient of Drainfisakteservo area D.)No Cut Bank(s)(greater than Sit and over 45 degfees)within ' 50ry,down gradient of DralnfieldAeserve area 'At E.)Use approved mitigation Jrom,section C1.S of the department of • �' a , ecology's'Criteria For Sewage Works Design'when cower. transport lines are wim.n 1.0f1 of wafer supply lines. O '0 CO t SD Zo Q `9-erc PAN c.)O SEA{ L.E IT-2- , P c-ELti 32 --1s vco(00 //' 5' L-I-0� � 485'T / J / / A- s-r 14.04 / � �/ ® �a 5'min to tanks•/ �;/ ti <s/ �; s h*j• 12'1 / , O ;, Ii,ed r' wt. *• L O / / , /' J ._-_d • to k3 rtftrv< 5��0� . / '/a'6 slop/e 6-X" RE/!kEt-5 ( 1f•1F1 / / ' /• µVi t.)M SAtJD • ,/ / / _ A.-lull-toll / r El./4 S . /Ea¢ '/ -/ 1 (1 0.'''i ** / Aipr•s�natt Fr . • r crw v„ sM �r• '�h v1+ C :1 `' stoo34g f ifQ a PAULA JOY JOHNSON'; 1 �• .�:rr �•. ©Au4ikaVtsua:Alum ail' =.::_ .„.� L c , 3 faesnota \ wsne ;t ,*,r 1 3Z120 012on Septic Tank \ ttm•et Rate O two Dettoc Pump Chamber t trx40.3 aR C: fl: 2' , 1:X'' A . . • SHo► t , IL NI - w . TLeas 1�1,. 3 AppR . — E.LITTLE 12,GI.R LANE— O VD MASONcp DEC 16 ?Ozy Nocytik Dm AC HEALTH 4s�q