HomeMy WebLinkAboutBLD2020-00477 - BLD Sewer Adequacy - 6/27/2022 1 SD2
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Public ! 'Health
Always working for a safer healthier Mason County
415 N.6th Street,Bldg 8,Shelton WA 98584
360-427-9670 or 360-275-4467,extension 400
Application for Determination of Sewer Adequacy
instructions:
1.Complete Part I of application. Permit number may be added at later date.
2.Take application, Site plan,and any other associated information with the proposed development to the Sewer
System Manager or Designated Employee for approval.
3.Submit completed application and information to Permit Center or Mason County Public Health for review.
NOTE:You must supply the System Manager with a site plan for the project,showing all existing or proposed
sewer components and lines in relation to proposed development and property.
Part 1:Applicant/Parcel Information
Applicant: J &J Development, LLC Date: 2/8/2022
Mailing Address: PO Box 137 city,State,zip:Fox Island WA 98333
Site Address: '9,9(e F,kric Cwe_a_ St-. Phone: 253-208-8136
Parcel Number: 12220 50 27006 ✓ Permit Number: '6 1 61 2024 ^ 004-I '-
Block L7 tot 6
Part 2: Sewer System Information
Name of Sewer System: Flo(\-\. //c TErAtt ® Site Plan attached?
Official use only: Sewer System Manager or Designated Employee is to complete.
()ZI New Connection: I have reviewed the applicants information and have no Issues with Mason County Public Health approving the corresponding
Mason County Permit.
❑ Existing Connection: I have reviewed the applicants information and have no issues with Mason County Public Health approving the
corresponding Mason County Permit.
❑ I have reviewed the applicants information and have determined sewer connection Is currently NOT available to this property.
(io Please add the following condition(s)on the corresponding Mason County Permit:(optional)
HA\Uc,} I"10,50n Cvt\\y.5 a5;9n cAN1 EQ(6 -rvc,k0A S yols CO( wu1-e..-
t1\4r Vie5. Posy Gpn11e.CA-to(\ cc,CTv&k. 2t,t1c,5 94_ z./q/zoz2_
Printed Name of System Manager!Employee Signature of System Manager!Employee Date
Pa 3: Mason County Public Health Review/Approval �e (� (2 ( �'"
Satisfactory ❑ Unsatisfactory `�/t'�l7 'f t Lo `�
// Signature of Envi nnC 1;14Specialist ^ n D`rte n
This form may be scanned and available for public view on the Mason County Web Site. (,J` �`I(
REVISED 10/282015
9f11~W APPROVED
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SANITARY SEWER LEGEND 0 ' 14,8.8 B
HOUSE 1212 SQ. FT. ® SEWER MAIN CONNECTION 26C/r
GARAGE 400 SQ. FT. ® CLEANOUT
FRONT PORCH 132 SQ. FT. EB LOT STUBOUT
REAR PORCH 88 SQ. FT. ®SANITARY SEWER MANHOLE
X CROSSOVER
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LEGAL DESCRIPTION ADDRESS 2g 0
LOT 6 BLOCK 27, 320 E BLACKWELL ST.
PLAT OF ALLYN, ALLYN, WA. 98524 J & J DEVELOPMENT LLC
VOLUME 1 OF PLATS, PAGE 17 P.O. BOX 2269
AP No. 12220-50-27006 GIG HARBOR, WA 98335
CEO 1857 (253) 208-8136
4" SITE PLAN MAP AGATE LAND SURVEYING, PLLC
G.BEit
c of A sit 4 PROFESSIONAL LAND SURVEYOR
f 0�� FOR 2680 E. AGATE RD. - P.O. BOX 246
q:`&,- 't`.,,... SHEL TON, WA 98584 - (360) 426-4172
:� J&J DEVELOPMENT LLC
IN THE JOB NO:
b 1 DRAWN BY DATE 01/18/2022
71 04148-2706
01 i °� . 28237 a :4w NW1/4 NE1/4 MJB
3's 4OISTEO 4 SCALE: 1 INCH =30' SHEET 1 OF 1
j�&AL LAO SEC 20, T221, R1 W, W.M. CHECKED BY
�4,. SGB FILE NO: 4148-2706_JJ_SITEPLAN.DWG