HomeMy WebLinkAboutBLD2025-00258 - BLD CD Environmental Health Review - 3/6/2025 e° li, MASON COUNTY COMMUNITY SERVICES Permit No:)II�2OZ")'O) &
7 PERMIT ASSISTANCE CENTER:
((( ,. •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
'0 615 W.Alder Street,Shelton,WA98584 +A
.f Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7 698 Phone
yO y� Belfait:(360)2754467•Phone Elms:(360)482-5269
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BUILDING PERMIT APPLICATION ��cFi 64
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: ANO
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NAMEk NAME: PT -Mc Q -'1'CaciQ
MAIL GAD RESS: CD MAILING DRESS: ' 4 W c7 ,
CITY: t. STATE: Z12 c CITY: STATE:(AA ZIP: '-
PHONE#I: GD e7( • PHO : Z. .
PHONE#2: et ;,,
EMAIL: 1�'cat'\ l t(\c.;Ck),COI TM # "`' 'p {cam[ P ygooie•cec_lefbg-
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PRIMARY CO A T �OWNE• ■ CONTRACTOR❑ OTHER, t4t' 4—
NAME y v11 Adirk EMAIL •
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MAILING ADDRESS I C2 Lott CITY STATE ZIP •
PHONE CELL
PARCEL INFORMATION: y�,�
PARCEL NUMBER(12 Digit Number) 3 22' -• -�Z•� ZONING 5
LEGAL DESCRIPTION(Abbreviated)0 I'.51;45501 2re i•o f-_�l ill FIRE DISTRICT
SITE ADDRESS 7() E , it . lap,�,� ' c+-c CITY
• DI CTIONS TO SITE ADDRESS I ' N -i-D me_ I . f ' ,C y (-
VIA? Driver Irk--06-6 �� i�L G-,J pj k•U .n a)I-�-
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREA R THAN 14%: YESU NO❑ SNOW LOAD:. psf
. IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWAlt.K❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR 0 OTHER`
USE OF STRUCTURE(Residence,Garage,Commercial Bldg Eta)
IS USE: PRIMARY$. SEASONAL NUMBER OF BEDROOMS v..
NUMBER OFBATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ (Part[r)ofBldg)❑ ,2IO❑
DESCRIBE WORK/4.1 CY)f erh ' Te41•'(6.' - wcp fe.4,\J e7tom orea-
• SQUARE FOOTAGE:(pop.)) .
1ST FLOOR sq.R 2ND FLOOR sq.ft 3RD FLOOR sq.ft BASEMENT sq.ft.
DECKsq.ft COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft
GARAGE sq.ft Attached❑ Detached❑ CARPORT sq.ft Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: �IES OF THE FLOOR PLAN REQUIRED*
4A.Kz 3D• YEAR --...--."---..„ LENGTH
17vIDTH BATHS SERIAL NUMBER ..---'-----------._ - �-
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTICX SEWtR 0 / NEW❑ EXISTINGX
PLUMBING IN STRUCTURE? YES ... NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NON. EXISTING SQ.Fr.
STING BEDROOMS C�
EXI (79
PROPOSED BEDROOMS
TOTAL BEDROOMS •
OWNER acknowledges that submission of inaccurate Information may result in a stop work order or permit revoation.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 iron 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 a^recs to the above described property
and structure(s)for review and Inspection.This pemit/applcation becomes null&void ifwork or authorized construction is not commenced whin 180
days or if consWon 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 / . Pa_
Signature of OWN (Must be signed by the OWNER) Date
5iEPARTMElN'T.e4LREVIEW_'-_ ;APPROVED DATE:-: _DENIED_ DATE":'.TAGS/RIOT ES/C'Ol\'Dr1TONS _
BUILDING DEPARTMENT ,_
PLANNING DEPARTMENT
FIRE MARSHAL `/ j� �y,� ��/�
PUBLIC HEALTH 6 SlfOf7•s _ WKO`Vn'�Iq 44� U •
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, fir.. 20C Ma•:
EH SETBACKS 0•1\
A)Drainfield/Reserve requires 10-setback from footing/foundations
B)Septic tank(s)requires S'setback from all footing/foundations
C)No foundation/perimeter drains within 30'down-gradient of drainfield/ _ /� r l 1 �1
reserve lNres (J M•t^ Wa„y 'fl per
D)No cut(s),bank(s)(greater than 5'&over 45 degrees)within SO'
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 Z 13 4^ S) —-b O J\ v6
Cl.9 of the DoE-Criteria For Sewage Works Design'. 1 (./
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