HomeMy WebLinkAboutBLD2022-00861 - BLD Sewer Adequacy - 4/27/2022 415 N.STH STREET,BWG 8,SHELTON WAB8504
MASON COUNTY SHELTON:300417-Bela EXT.400
COMMUNITY SERVICES BE ELMA 306275-4487.EXT 400
ElMA:9Wd025108,EXT 400
Bush",Plennly,Envw rovanrel HeaNA Ummunlry H.111, FAX:300-427-T7B0
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 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 Pemlit 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 I Parcel Information
Applicant Sam Martin,Agent for Lennar Northwest,Inc Date: 4/27/2022
Mailing Address: 33455 6th Ave S, Unit 1-B City,State,zip: Federal Way,WA,98003
Site Address: Model Home HS 143 Address TBD Phone: (253)294-13n
Parcel Number: lnl8-EB-00000;12328-24-00000 parwrparcds permit Number.
Part 2: Sewer System Information
Name of Sewer System: VCLYA,C [j] Site Plan attached?
Official use only: Sewer System Manager or Designated Employee/s to complete.
III, Naw Cannes ion: I have nevievea the applicants adoreaticn and haw no iseassetM1 Mason County Public Health appvAnp the whaeawding
Maven County Permit
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Part 3: Mason County Public Health Review/Approval (^^ ^
Satisfactory ❑ Unsatisfactory REMUD,y 1 l '
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This form may be scanned and available for public view on the Mason County Web Site.
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