The URL can be used to link to this page

Home My WebLink AboutAPPLICATION FOR EXTENSION SWG2022-00372 - SWG Application - 7/16/2025 of-.141/4_ MASON COUNTY 415 N6H` STREET,SHELTON WA 98584 SELTON: 360-427-9670 EXT.400 M Public Health & Human Services BELFAIR: 360-275-4467. EXT.400 APPLICATION FOR EXTENSION cce,� Amount Paid: It ( S JUL A6V" Receipt Number: 5'. 0361a iJJ Instructions: Applicant to complete Parts 1 and 2 and septic designer/engine p ete Part 3. Submit application with extension permit fee. Make check payable to Mason County Treasurer. Staff will review your application and determine if the extension can be approved. Conditions for approval are outlined in this application. Prior to or after expiration of an approved design, the applicant may apply for a permit extension. The permit extension shall extend the expiration of the design for up to two years, but not exceed five years from the signature date of the Environmental Health Specialist's site inspection{Per WAC 246-272A-200(4)(e)} All approved septic designs may receive one extension. Additional extensions shall not be accepted and would instead require a renewal. PART 1: APPLICANT AND PARCEL INFORMATION Name of Applicant: AQ_P 'Pe,1`e Phone: ZS�-1,0c — 4L S- Mailing Address of Applicant: 550 City: CST C-445`r- State: Zip: 61 (cJ � 12-digit Tax Parcel Number: 2 J ° Z-' -4 Site Address: �- �\St S" 1'\ sCYNA‘ Uv, 9 -� Lk- Permit Number: SWG �G2 - -" (5)03 - PART 2: EXPLAIN WHY YOU NEED AN EXTENSION es c - . a \P 9N.,<NY`'L This form may be scanned and available for public view on the Mason County Web site. Page 1 of 2 PART 3: ORIGINAL DESIGNER/ENGINEER REVIEW AND APPROVAL I, the undersigned original Designer/Engineer, attest that I have reinspected the property and found the following conditions to be true as of the date of my signature below: • NO part of the proposed Drainfield or Reserve area has been altered or disturbed in such a way that may render the proposed design invalid. • NO development has occurred on this parcel or neighboring parcels which would cause the proposed system to no longer meet minimum setbacks. • NO Boundary line adjustments or subdivisions have occurred which would cause the property to fall below the minimum land area requirements of WAC 246-272A. I7).'ia-f t "Stain 415: .. "4� 44:4,01 .4 s '-c Lp‘-2' y�tt. s,o.aaa '.c�:�'ti Signature of Designer/Engineer DateI FAULA JOY JOH:'JSGN -•." ) —1_1, (0 -2 S— 0 Comments/Conditions: \_ .-QA, CZI•&.-)`(`kL-�-'e✓\ -\\( c C - c} -- p iir ,tom.— PART 4: HEALTH DEPARTMENT DETERMINATION (staff use only) ❑ Extension Denied Extension Approved New Expiration Date: 7r/ �0 I ZO Z 7 Comments: 441pp,kb Environmental Healt Specialist Signature: ttoe 4,14s JOB >> Y� 2025 This form may be scanned and available for public view on the Mason CauftyWeb site. Page 2 of 2 415 N 6TH STREET,SHELTON,WA 98584 MASON COUNTY SHELTON:360-427-9670,EXT 400 ` BELFAIR:360-275-4467,EXT 400 Public Health & Human Services ELMA:360-482-5269,EXT400 FAX:360-427-7787 ENVIRONMENTAL HEALTH REVIEW OF OSS APPLICATION FOR EXTENSION PEREIRA HEATHER & JERVIS 5503 51st Ave Ct NW GIG HARBOR, WA 98335 Applicant: PEREIRA HEATHER &JERVIS Parcel Owner: PEREIRA HEATHER &JERVIS Site Address: XX E Geist Meadows Primary Parcel Number: 221337900050 OSS Permit Number: SWG2022-00372 Permit Description: New 4bd ATU to Oscar II with permit expiration extension Permit Submitted Date: 06/28/2022 Permit Review Date: 08/04/2022 The above mentioned Onsite Sewage System Application was reviewed by Environmental Health and found more information is required. Your Application for Extension for septic permit SWG2022-00372 was approved. New expiration date: 7/20/2027. If you have questions or concerns let us know. Sincerely, David Anderson 360.427.9670 x353 danderson@masoncountywa.gov