HomeMy WebLinkAboutBLD2025-00767 - BLD CD Environmental Health Review - 6/26/2025 •
MASON COUNTY Permit V 'a�
COMMUNITY DEVELOPMEN[ 20 2025 G
..� Permit Assistance Center, Building,Planning ciN 2�
BUILDING PERMIT APPLICATION 615 w•Alder Street N7 ,O
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: wt w f
NAME: LyNN 5 /4- 5t c ( NAME:
MAILING ADDRESS:of 72 E. s4.h. 1Z4.S MAILING ADDRESS:
CITY: 51..4161, STATE:%t/A ZIP:185-a`/ CITY: STATE: ZIP:
PHONE#1: ;Go• 241.•'IOIZ PHONE: CELL:
PHONE#2: EMAIL:
EMAIL:iVuM5CJMm4¢a8 C 10.,,;I.�,„ L&I REG# EXP. I_I__
PRIMARY CONTAC1-T: OWNER® CONTRACTOR 0 OTHER
NAME Pr .ev SLIids$4t/ EMAIL fpresk'►« 897 O XGLCI6uD• (a w1
MAILING ADDRESS 4,71- E. iI•• ¢L• 3 CITY 3I,e.1 ha. STATE W ZIP dUk58Y
PHONE CELL 3f a•7!0 -90?11
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3ZI 3SY3OD I5D ZONING 2. 5'
LEGAL DESCRIPTION(Abbreviated)V. t $LA *f 3'73 A F %S9K748 FIRE DISTRICT
SITE ADDRESS 44171. E. 6W.( 3a. 3 TIN •f SW 0/SE CITY 3tnel4s6.e
DIRECTIONS TO SITE ADDRESS t•I re iit, 9th% ic.10.oft 64,3 43 V`,'^ t nN R•fkF
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO El SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that appy)
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ta ADDITION 0 ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Erc.) &shale
li IS USE: PRIMARY❑ SEASONAL 0 NUMBER OF BEDROOMS 0 NUMBER OF BATHROOMS 0
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Parris!ofBldg)0 NO E
DESCRIBE WORK Ilk SarIg.v /Ga•••y
SQUARE FOOTAGE: (proposed)
1ST FLOOR'4.11P sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ 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:
�� $y GE EWE VOICE: SEPTICg SEWS 0 / NEW❑ EXISTING a
FL A U TUBE? N , If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED?/// \\\ YES 0 NON 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 this permit and to do the work as proposed.I have
obtained permission from all the necessary parties.inducting 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 18 DAYS 0 ,..,.•- • WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
�l TY CODE 14.08.42)
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nature of OWNER(Must be signed b °y NEB) Date
DEPA MENTAL REVIEW APP'AM'D DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �/ [J�
PUBLIC HEALTH $j11!-e r'(nAli
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EH Setbacks
A.) Drainfield/Reserve requires 10'setback from footing/foundations . ft •
B.)Septic tank(s)requires 5'setback from all footing/foundations Al
C.)No foundation/Perimeter Drains within 30ft,downgradient of /` o
Drainfield/Reserve area Cr:D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within ` r' !�
50ft,down gradient of Drainfield/Reserve area M Q
E.)Use approved mitigation from section C1-9 of the department of
ecology's"Criteria For Sewage Works Design,"when sewer Vt.transport lines are within tOft of water supply lines. c ,1 'Z-
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EH APPROVED a 3
Rhonda Thompson 08,0412025
07/28/2025
APPROVED
MASON COUNTY DCD PLANNING _
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RR5 Zoning '
Front Yard Setback.25'.
Side& Rear Yard Setbacks. Residential dwelling
and accessory structures is 20'.
OR 10%width of lot if not more than 100'wide
OR approved ADV r
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Disclaimer: Mason County does not require a
survey to obtain a building permit. As a result, site -
plans may not reflect accurate data. It is the
applicants responsibility to comply with setback
requirements.