HomeMy WebLinkAboutBLD2025-00402 - BLD CD Environmental Health Review - 4/2/2025 •
PROPERTY OWNER INFORMATION: �'• T,11� OR INFORMATION: I z
NAME: Roy tr V V. t (Qt 41 t A RNO►t1>1�ask Nowt. (3,,I(Jtrs 66 t C
MAILING ADDRESS: 1t-X Cltval�t c4. MAILING ADDRESS: PO Flo v 77.1 x X)
t CITY: o4.L��4.4t STATE: WA ZIP: ¶f 5 .Alder Cs4qpiita STATE: WA ZIP: embec rn 0
PHONE#1: (%o) 5n-W19t/ PHONE: o g O- t ELL: s44 e D Z
PHONE#2: 0Got VI;.O 4i 4 6 EMAIL : AAA h e . tts ram;I. tom K
EMAIL: con,to UR 4aso0 •G0$44 L&I REG# M AS Mitt a 79 I Kl 'XP. 6 / I /so. rrt
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PRIMARY CONTACT: OWNER 0 CONTRACTOR m OTHER 0 I —1
�NAME ArCW EMAIL v►aStt koktc.c- IO,z irltl'a a - l•CQI r??'MAILING ADDRESS ye.41,
O Do Z CITY • ra STATE W A $
PHONE CELL 405840 K9 4/Op� ~�
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PARCEL INFORMATION:PARCEL NUMBER(12 Digit Number) 1 2 1015 OO 102.3 ZONING nn h RF �4
LEGAL DESCRIPTION(Abbreviated) Q'.rw%+Cfi Coot b l ldb .3 I La+ 2 FIRE DISTRICT Cj k
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SITE ADDRESS 4110 E. bake:L L4 QQ. J CITY t4 .eIli CW
DIRECTIONS TO SITE ADDRESS .it to: L c CI I
4w.t S. ek%LoAttar t Li. S,TLers tie on E.Mr. Cavc U.,t1 4 L4 ?l'Ow a o.LA f1-a.. G.task,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES! NO 0 SNOW LOAD:a6 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER RI LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW P ADDITION 0 ALTERATION ❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage.Commercial Bldg.Etc.) IZILS1 CL-
IS USE: PRIMARY g SEASONAL 0 NUMBER OF BEDROOMS Z NUMBER OF BATHROOMS Z
HEATED STRUCTURE? YES(Whole Bldg)la YES Mortis)of Bldg)0 NO 0
DESCRIBE WORK AC QCS:k'1k:4i---____-__
SQUARE FOOTAGE: (proposed)
1ST FLOOR ►Goo sq.ft. 2ND FLOOR sq. ft. 3RD FLOOR sq.ft. BASEMENT sq. ft.
DECK sq.ft. COVERED DECK 1 S I 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 MODEL YEAR LENGTH
—
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC® SEWER 0 / NEW id EXISTING 0
PLUMBING IN STRUCTURE? YES14 NO❑ )f yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 71 NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 2• TOTAL BEDROOMS 2. .........__..
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 if 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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
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Signature of OWNER(Must be signed by the OWNER) Date
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INSTALL OSCAR X02 PER
MANUFACTURER INSTRUCTIONS
CASE
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PROPOSED OSCAR ....../\ INLET
X02 TANKS. 50'+
TO SHORELINE
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PROPOSED �•
2 BEDROOM
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OSCAR X02 � /
W/ RESERVE '
\\ FUTURE
1 2)I _U ' / c \\ I-IOME -
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. AA �\ - `\ , APPROXIMATE /
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1411i � BUILDING SETBACK
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• (30 TO DOWNSLOPE
.N FOUNDATION DRAIN)
FUTURE WATERLINE
`' DOUBLE SLEEVE WHEN
-3 w/IN 1OFT OF DRAIICIFIELD `, r'^ ,,r'"„�'"., 7
or f i+ G p'r)�3
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AN ASBUILT!INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
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C.II�T��1tl-.R: RON COVAL I LEI I h`LI'I: l l:�f HOLE L:
PIONEER DIGGING, INC. ,,— �i T'4
PAR 1-.R: &50 01023 I+—v.�l I c 1.�1 h+\I..."i 1..1 \I
Si 1PTIC. DESIGNS Al)1)RF_t:: 90 E BAHAMA DR.
�}�, OOCIAIMER TN61{SOT A SURVEY.REfiREACEs�NCEIOE MRIICAVflCCL
r 3O$ E MA:-.'�Rf\�.��1 RA/,GR.MEI IE��,�l' `�t�I LAC E� FATE PAYSSE RUTS ORSURVE,S Act t Y0.4.1 MCAT :;:0Nh GIS ts,..!....!rOJRSEPTC
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1 ` '' "�Veciinn F(v��. 7 2. 3 \}IF 1: SITE fl}N r=JE1 CEDMTME•aorFofv Kona* DES GNER NOT RfSV�fdBE CFI 5ET7SC[S UNRELATED TC
SEPT.0 cOV�7NE`TS