HomeMy WebLinkAboutBLD2025-00519 - BLD CD Environmental Health Review - 5/6/2025 (1-.00:s:P444:ye,. MASON COUNTY COMMUNITY SERVICES Permit No:?l(1 2O) EOM E D
PERMIT ASSISTANCE CENTER:
' BUILDING•PLANNING•PUBLIC hEALTN•FIRE MARSHAL
I g ■,�7 . r 'S 615 W.Alder Street,Shelton,WA 98584 APR 2 8 2025
`may r�i
Phone She!lon:(360)427-9670 ext 352•Fax(360)427-7798 Phone
- Y Be)fair.(360)275-4467•Phone Elms:(360)482-5269
•IiirK''� 615 W. Alder Street
BUILDING PERMIT APPLICATION Hi_ Ikm. le• • Ll(.
PROPERTY OWNER LNFORlZA.TION: CONTRACTOR INFORMATION:
NAYLE:bytci bV1 �`/ +l.NAME: H ) I i v1.Qi.T lOi} �1 t
MAILING ADDRESS:- b fA 1 'vita-hu.L)K. MAILING ADDRESS: -5'
CITY :)-hP (/v� _STA 'Y • ,A : -- CITY: STATE: ZIP: 9�
PHONE rr 1: (,`)(O l), r 10I ) 1C i
j 4 PHONE: CELL: <I .p
PHONE 42: • ^ EMAIL: d'
EMAM: �r�. �Lpct : , ) T.RrI REG?r EXP._/ /_ GIN
PRIiVMAR 'CONT r (OWNER❑ CONTRACTOR❑ OTHERX `r
NAME }�'IL(tit L)'r'x- f` .1 EMAIL •
PHONE MAILING ADDRESS ( CELL 14 U(, LI
• • 1' ZIP .
PARCEL INFORMATION: MI KE'C1 06
PARCEL NL ER(12 Digit Numba) Li cA C;2 l -3 • 4 ob•Tj I ZANIG S ht U(!rl Lx-9 A
LEGAL DESCRIPTION(Abbrniatted),/ !� ` ,} FIRE DISTRIC i
SITE ADDRESS W 7&r! C)vie L-' K.L l.� CITY 6 h -LJZ'�L_
CTIONS TO SITE 4DDRESS, r!
4/j , A %1.)�. - �e` ' ) i c .- i- t:Lbv►-ic1 1 ien�et,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YE NO El SNOW LOAD: psf �/'C4YLx�1ele
IS PROPERTY WITHIN 200 FT OF DIE FOLLOWING: (Chen kall rherapply):(10 u
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW,ADDITION❑ ALTERATION 0 REPAIR❑ OTHER ❑
1
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Era) n EI A; 3[(2
IS USE: PRIMARy.er SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOM .:5
HEATED STRUCTURE? YES(�neleBldg)❑ .YES(Par[s]cfBldg)❑ NO
DESCRIBE WORK CO h� Y L'C)� n F, 1,0 j '.14 .
• SQUARE FOOTAGE:(propered) i1QLT(.4L.U60 in I X/61 ()6E
1ST FLOOR I qD sq.ft. 2ND FLOOR sq.f. 3RD FLOOR sq.ft. BASEMENT sq.ft_
DECK ', sq.ft. COVERED DECK��L sq.ft. STORAGE sq.ft. OTIMR sq.ft.
Far))T sq.ft_ Attached❑ Detached❑ CARPORT sq.ft.Attached❑ Detached❑
i1 ANUFACTURED HOME INFORMATION: *4 COPIES OF 113.1.FLOOR PLAN REQUIRED*
MODEL YEAR LENGTH 1
7DTH BEDROOMS BATHS SERIALN
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC/ SEWER 0 / NEW/ EXISTING❑
PLUMBING TN STRUCTURE? YES/ NO❑ If yes,attach completed Water Adequacy Form
I PERIMETER/FOUNDATION DRAINS PROPOSED? YES/ A NOD EXISTING SQ.FT.
EXISTING BEDROOMS U PROPOSED BEDROOMS S TOTAL BEDROOMS `S
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revoo5on.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 .
11 obtained permission from all the necessary parties,Including any easement holder or parses of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County s— ss to the above described property
and structures)for review and inspection.This permit/application becomes null&void 6 work or authorized construction is net commenced within 183
days or if constection won It is su- died for a period of 180 days.
tiolOF OF ONTINU•',i[y>•v OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
'MIT APPLI •TIO, e 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
ACOUNTY CODE 14.08.42)
X ,- 17//'-- 2�. —
.4StgnaturecfOWNE• ••stbe/signed •ytheOWNER) Deie
DEPARTMENTAL_REVIEW I,APPROVED'.'-1 DATE'' DENTED DATE TAGS/NOTES/CONDTTIONSl
BUILDING DEPARTMENT
0 PLANTIING DEPARTMENT
FIRE MARSHAL - I I ' n _ n
PUBLIC H EALTH I j [21-V't�r L t'r 01 - c
fft `.
1Q�1�r�L�
L)6 .. Mt X 'C I UAL. EH APPROVED ------ -. (y Z _ ---
Rhonda Thompson 06/03'2025
EH Setbacks
A.) ld uirndations A
B.)SepticDrainfie tankReserves)requiresreq 2'setbackes2' fromsetback all footingifoundationsfromfootingnou
G.)No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
67 50tt,down gradient of DrainfieldiReserve area
E.)Use approved mitigation from section C1-9 of the department of
ecology's'Criteria For Sewage Works Design.'when sewer
`�
OC)i''d transport lines are within 10ft of water supply lines.
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May 30, 2025
Mason County
Environmental Health Dept.
To whom it may concern,
As of this day, I can attest the septic system installed at 331 West Berry Ridge Rd
Shelton, WA 98584 (MC parcel 42024-34-90051). This Septic System remains unused.
Andrew ear Owner pr r to April 11, 2025.
Chad Burgess Owner Since April 11, 2025.