HomeMy WebLinkAboutBLD2022-00870 - BLD Sewer Adequacy - 7/12/2022 415 N.STH STREET,SLOG e,SHELTON Manias
MASON COUNTY SHELTON:30427-9870,EXT.400
BELFMR:and)-275 482-5M7,EXT.400
COMMUNITY SERVICES
ELMA:a90-092-52aB,EXL 400
Bulltling,Planning,FmhonmertAHeaW,CommuMly H.1Ih FAX:3W427-7]BB
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of application. Peril number may be added at later dale.
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 of 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: Sam Martin,Agent for Lennar Northwest,Inc Date: 7/12/2022
Mailing Address: 33455 6th Ave S,Unit 1-B City,State,Zip: Federal Way,WA,98003
SileAddress: HS 144 Address TBD Phone: (253)291-D2�2�/'�
Parcel Number:
12338-21-00000:12a2a-14-00000 parentperok Permll Number: W_/ 00
Part 2: Sewer System Information
Name of Sewer System: Behar Site Plan attached?
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only: Sewer System Manager or Designated Employee Is to complete.nnwgan: I have revieweounty Pmmll.Connection Ihaw mvl—out Weepplicann lohnnadon end have m Issues Mth Maven County Publie Health approving the
noin9 M.San County P./mll.
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Part 3: Mason County Public Health Review/Approval
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%.Satisfactory ❑ Unsatisfactory D rV 1
Signature of Eovhonnron Haehh Specialist Oele
This form may be scanned and available for public view on the Mason County Web Site.
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