HomeMy WebLinkAboutBLD2025-00749 - BLD CD Environmental Health Review - 7/8/2025 .tom Lj�6//�
MASON COUNTY COMMUNITY SERVICES Pew No:��12 VJ� ,. j�
7 y?
, (7.,•. P ERMIT ASSISTANCE CENTER:
... froi l•BUILDING•6PLlWN/H 15 W.Alder Street Shelton, A 98584 F C E I V E U
- - ;,/ Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
/ Belfair(360)2754467•Phone Eimer(360)4825269 J U N 2 0 2025
BUILDING PERMIT APPLICATION
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PROPERTY OWNER INFORMATION: cONTR�3CF() NFORMA I et H `ENTAL
NAME: 0��r tVt t +C�11 NAME: `�1_ Pi.
MAILING ADDRESS: gg(.35 Nt 22►tct 54t MA]LINGADDRESS:
CITY:iu W c‘. STATE: ' i ZIP: C fig gat) CITY: STATE: ZIP:
PHONE#1: 2ob - 7 15-416 7 5 PHONE: CELL:
PHONE#2: EMAIL
EMAIL: Mr OAtki,etk 253t `6Ahc04cn L&I REG# EXP. / /_
PRIMARY CONTACT: OWNER 12 CONTRACTOR) OTHER❑
NAME k C.J.h .^1 t(tie 1I EMAIL t/
1 MAILING ADDRESS 44 y D 5 W, Z 2.rs cl SA-. CITY W�.....— STATE 1l/P ZIP ct 47C t� G s
PHONE �44 -11 S"-COO CELL 20 6 - TIC- 1.4t 7j 'P
PARCEL INFORMATION: 0 cp
PARCEL NUMBER(12 Digit Number) 3 2 Soo 3 O ZONING
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LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS F v'J - 7 c b" a Ic 1 Z CITY
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DIRECTIONS TO SITE ADDRESS S. no r}h s i.c•t� R o, )c� M, i �.� a F- B C'1( '- G
(Z-0a tanc1 LitcK (ZQ I L. ® i
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IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESK NO❑ SNOW LOAD:_ psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check kiden apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW bt ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg Etc.) ( Lb i t1
IS USE: PRIMARY❑ SEASONAL I . NUMBER OF BEDROOMS lis NUMBER OF BATHROOMS e.
HEA I ED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s]of Bldg)121' NO❑
DESCRIBE WORK Nevi Lc r . clec-e 115a 1-1 -I•t 1 !4 3 4, 40 4�(
SOUARE FOO GE: /tom"
1ST FLOORS� .ft 2ND FLOOR�76A sq.ft. 3RD FLOOR d 'XI BASEMENT a sq.ft.
DECK 120 sq.ft COVERED DECK 9 V sq.ft STORAGE IV sq.ft. OTHER 2t' sq.ft" h
GARAGE_7 Ry sq.ft. Attached g,Detached❑ CARPORT sq.ft Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
TH BEDROOMS BATHS S
ENVIRONMENTAL HEALTH:
SEWAGFJSEWER SOURCE: SEPTIC-% SEWER / NEW❑ EXISTING tiC
PLUMBING IN STRUCTURE? YES"( NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ Noici EXISTING SQ.FT.
intimation
BEDROOMS 0 PROPOSED BEDROOMS x a i TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate ation may result in a stop""""wort order or permit revocation.Admowledgentent of such is by
signature below.I declare that I as 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 Merest 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 proper ty
and structure(s)for review and inspection_ This pemiittapplicabon becomes null&void d work or authorized construction is not commenced within 180
days or if oonstntction 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
PERMI APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNIY CODE 14.08.42)
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Signature of O R(Must be stand by the O ' ' R) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDTTTONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL � Q� (
PUBLIC HEALTH C`r a1Zc' `Jw P
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EH Setbacks
A.) Drainfield/Reserve requires 10'setback from footingifoundations
B.)Septic tank(s)requires 5'setback from all footing%foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield.'Reserve 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 -V
ecology's"Criteria For Sewage Works Design,'when sewer ' x_
transport lines are within 10ft of water supply lines.
EH APPROVED 4a -It' c.• A . Qt�,\\ t�
Rhonda Thompson 09'08.2025 - 'i J
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PLANNING SETBACKS s�, ___.
10
Setbacks measured from
farthest projection of structure \oEt,-
Front:25' ck c,�\"°>
Rear and Side:20' kea / ill")'Subiect to EH Setbacks 0‘15P
"Must also meet slope setback of 15'
10 APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO APPROVAL
/e/ 08/04/2025
By: Date:
ti
S 1 r g Plan / %
fv\t*-e.hv\\ S Z=R Removal of native vegetation,
installation of impervious surfaces,or
0oste\ t 3?2_t 9 T 5 oo 31O grading/fill in the buffer is PROHIBITED.
"Ti Buffer is 5'from top of slope and 75'from stream