HomeMy WebLinkAboutBLD2025-00773 - BLD CD Environmental Health Review - 6/27/2025 nay / 1
' , MASON COUNTY COMMUNITY SERVICES Permit No:�) A P) -VI IA 7
/A PERMIT ASSISTANCE CENTER:
{y •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
1 /;J h7 0 615 W.Alder Street,Shelton,WA 98564
yL''v/'•~ /'
y.� Phone Shelton:(360)427-9670 ext.Phone•Fax 360)4 2-52 98 Phone ✓��
�sy ''�yy Belfair.(360)275-0467• Erna:(360)482-5269 V
BUILDING PERMIT APPLICATION /Q 2
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION�C�L� '�s
NAME: 1415 c‘C) C.[.C.— NAME:al(/ A q- C.. .. 4 t .L: It
MAIL ' ADDRESS: a4t O 3''L7 (5.*•MAILING ADDRESS: i / -12/ —
CITY: 0!l i STATE: ZIP '1 CITY: �`// i STAT : Al':4,1
PHONE#1: (V2 -Lc/ /,3t6 PHONE:
PHONE#2: EMAIL: .1 ..
EMAIL:i4"Id /V 29 411`"id.CI fe4 L&I REG# . AC/ I/4 rn
PRIMARY CONTAC : OWNER❑ CONTRACTOR' OTHER❑ rt
NAME .lG EMAIL 't--,
MAILING DDRESS CITY STATE ZI? S .
PHONE CELL 2 "
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 31.02_1 — r4—01 t>Z ZONING A
LEGAL DESCRIPTION(Abbreviated)i5 kCc4i--g et) ..4., FERE DISTRICT
SITE ADDRESS 3 5-1 13 CL t 40,2 G•.'I CITY 6,6,67 LY(i
t DIRECTIONS TO SITE ADDRESS 3 /44 elf / GG J
Z 4 4 L(C L4.01 o sts-, GICV 5i 'vw z >AA.
IS 1BL PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES VNO❑ SNOW LOAD: pal •
IS PROPERTY WITHIN 200 FT OF 1HL FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER�
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.E:c) et�t 4 /,,,,„0` zpi t
x •
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROO S NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(K'noleBId ❑ [s]o Bldg)❑ NO❑
DESCRIBE WORK X e 41 l r0G
SOUARE FOOTAGE:(proposer)
1ST FLOOR ,( 'lg.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft_ BASEMENTft.sq.
DECK. `Sea.R. COVERED DECK C) sq.ft. STORAGE sq.ft. OTHER 1140 sq.ft.
GARAGE r sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: • *4 COPIES OF THE FLOOR PLAN REQUERED*
MAKE i MODEL YEAR I FNGTH
WIDTH BEDROOMS BATHS - SERIAL NUMBER.I _
ENYtRONMENTAL N I.ALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER / NEW((( EX
ISTING❑
PLUMBING IN STRUCTURE? YES❑ NO If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES t.. ONOD 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 the 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 ar rs to the above described property
and stnicture(s)for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if oorstruction 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
OUNTY CODE 14.08.42) _
X Z C72.‘,
i Signature of OWNE,W(Must be stoned by the OWNER) Date
'IIEPARTE1 INTAL REVIEW: ::APPROVED'::,i DATE'-'.- = DENIED_ DATE-.r.'TAGS1NOTES/CONDITICINS _
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL I
PUBLIC HEALTH I git/ 1J(b C/t Sh aid
1
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(1, .:. „IL tk 4 ,
t- fir tU Cut behind house must not
,` exceed 5'. Maximize distance
-7: from reserve DF.
7a 6Z \ •
-
EH APPROVED jttd2( z4 .1} '
Rhonda Thompson 0711 6/2025 10 -fjGL)G� 11-1c ww 1
•
- ' o s` I -
No setback from upgradient 1 C- \(7 \
perforated drainpipe to
tanks.Ensure tank will not 0 r' �/ A
be structurally compromised 1 `1��„r/ /Aii Ail- WA I I
by weight of retaining wall. O ++�4 10'min from drainfield to
ipgradient perforated drain ipe
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o� �ti�n� G� vON li •
PP..PosE-D w rGQ--
F. C.3F�‘DG EPA L I
EH Setbacks -
A.) Drainfield/Reserve requires 10'setback from footing foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of
DrainfieldiReserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield'Reserve area
E.)Use approved mitigation from section C1-9 of the department of
ecology's"Criteria For Sewage Works Design."when sewer
transport lines are within 10ft of water supply lines.