HomeMy WebLinkAboutBLD2022-00856 - BLD Sewer Adequacy - 7/12/2022 415 N.BTH STREET,81-W 0,SHELTON MNN4
MASON COUNTY SHELTON:9ee427.9870,EXT.40
BELFM :90037a4487,EXT.400
COMMUNITY SERVICES
ELMA:980 482-6208,EXT.400
Building Plannhg.E"Ironmemal Walsh Community Health FAX 350.427-7700
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 Permit Center or Mason County Public Health for review.
NOTE:You must Supply the System Manager with a She 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
Meiling Address: 33455 6th Ave S,Unit 1-B city,state,zip: Federal Way,WA,98003
Site Address: HS 140 Address TBD Phony (W)2e4U22
Parcel Number: 122U8-21-00000:12328-M-00000parenrparceb Permit Number: 'Pit�2o (.Z�OvW q
Part 2: Sewer System Information
Name of Sawer System: Behar 11 Site Plan attached?
Official use only: Sewer System Manager or Designated Employee is to complete.
Newctoccosa. I have reviewed the a,hothnls lnrwmallonees haven.haueswiln Maw County Public Heelth appolnO the coveapontlin0
Mason County Pelmll.
❑ EXISBnaConn0o0oe: Iheve rovlewetl Ole eppllwnU inlwlretion antl hive nolaauas wiO Mswn Count'Public HeelOepsositp Pe
ounaspooso,Meson County PmmO.
❑ Ihavereviewed lheepplioulu lnrmmadoo and have tlelermined some connection is astern,NOT available lo this prupedy.
[� PleneatlOMerolbwMO cmMlllonh)on the concepotul,Maw County Pearat(eplavMO
I Pa. Lc'a oP 1112,00 (.ogrd'w.4e "L'5911+ (y.1, 5rnarLoaot �o11aL� MB,SaxT
itnnLlyc Sew �� & 1 4,netlucli" 56-nd�d�
1 Ts6r �I� ILL I 2
Pon.Name deyalm Mnaau/Enio, I SbuWnd9yMmMwpsr FmlMA'as Bala
j Part
3: Mason County Public Health Review/Approval r-b '7
I l alisfectory ❑ Unsatisfactory V
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This form may be scanned and available for public view on the Mason County Web Site.
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