HomeMy WebLinkAboutBLD2025-00209 - BLD CD Environmental Health Review - 9/27/2025 ENVIRONMENTAL
HEALT I RECEIV D
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: FEB 2 0 20 '
NAME: J JI�I I a='CR \.1OODGCx-R NAME:A LIVEC.HT CO1.�rgouri '4
MAILING ADDRESS:4018, W. 13r14 MAILING ADDRESS:35r I LA,b p�j,�der S :-t
CITY:- �CaMA STATE: lsu ZIP:9mot, CITY:posit ISLAND D STATE:y ZIP:9S 33,i
PHONE#1: 415 - 6142 - to,sc, - PHONE:_ CELL: 9,9-4,83-11.57
PHONE#2: EMAIL :AtjagEC+1 rcoi.JsTRacncri).NMC4(!c 0104, •In
EMAIL: J VJOODGOGK O Nvt'MAII..r lam,1 L&I REG# 6704 31 I GOJ' EXP.pYjV,/goz5
PRIMARY CONTACT: OWNER❑ CONTRACTOR OTHER
NAME 1 1 i-1 EMAIL L E Ci1Gu.Nio< tor4) ,COM
MAILING ADDRESS 35 ! 19.M1t V D. CITY t.AmN STATE ZIP-%k=1=_
PHONE CELL -((f33-
PARCEL INFORMATION: ,�� G�•.
PARCEL NUMBER(12 Digit Number) .dz fo( - 62- 06004 ZONING R .R5 �? w
LEGAL DESCRIPTION(Abbreviated) NW 4A AI `r:.c..i r22N R4Wi 1 FI�R1E DISTRICT I '.,'''� ', .
SITE ADDRESS 7Z,5j640 (U, L Hwy KM
1 , r"'CITY f� Fr ai Q F� V>
DIRECTIONS TO SITE ADDRESS I. 3 Ri I I..C-S hlrozrtl r Nobs:-PI)kir Ole.) CAST
.�►o OF' I-4'&14\ A'1' Vi 1 .
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES® NO❑ SNOW LOAD:as csf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER® LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW N ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.C:onunercial Bldg.Etc.) VA C-AT-1 pN RL S I)[JJGG
IS USE: PRIMARY ❑ SEASONAL® NUMBER OF BEDROOMS i. NUMBER OF BATHROOMS 1.
HEATED STRUCTURE? YES(Whole Bldg)El YES(Partlsf oJBld2 0 NO 0
DESCRIBE WORK S-T"'I ad.. C01,15rR>aCi 1CJ1 ? FOUk1 DArtc,fJ Wlitt ! A`JZ-C FI C ,
SQUARE FOOTAGE: (proposed) N
1ST FLOOR.4.53 sq.ft. 2ND FLOOR sq.ft. eRD FLOOR I � S sq.ft. BASEMENT
��,,�p�� ppsq.ft.
DECK 2�DD sq.ft. COVERED DECK sq.ft. TbR E Itto" • sq ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
'Ii
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH •
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC N SEWER❑ / NEW❑ EXISTING El
PLUMBING IN STRUCTURE? YES® NO❑ if yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES pa NOD EXISTING SQ.FT.
EXISTING BEDROOMS QS PROPOSED BEDROOMS I TOTAL BEDROOMS I
/�
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by ,s,
signature below.I dedare 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,including any easement holder or parties of interest regarding this project The owner or legal 6
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 cormrenced 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 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X t=cg LO 2,Oz6
Si re oAf ER(Must be sianed by the OWNER) Date
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