HomeMy WebLinkAboutBLD2023-00480 Lot 98 - BLD Sewer Adequacy - 2/9/2023 Acct#400428
416 N.BTH S RW.8LDn 8,WELTON WIaBSN
MASON COUNTY SHELTON a 77-9570,E ..4ap
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pan 1 of application. Permit number may be added at later date.
2.Take application,Site plan,and any other assodated 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 Meson County Public Health for review.
NOTE:You must supply the System Menages math a site Plan for the pm)act,showing all ealating or pmpoaed
sewer components and lines In relation to proposed development and property.
Pad 1:Applicant Parcel Information
Applicant Sam Martin,Agent for Icnnar Northw"t4 Inc Data: 02/09/2023
Mailing Address: 33455 6th Ave S,Unit I-B city,state,zip: Federal Way,WA,98003
She Address: 31NEOImpk RWar•Addmo5ubicnmy,mat Phone: I]S31294-132]
Parcel Number. 1>!>e-21- k�T�� Permit Number: �iLl Lb 3"/��`T��
Part 2: Sewer System Information � I 1. —10
Name of Sewer System: adfih ® Site Plan etladeN
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nty: Sewer System Managsrar D"Wgnared EmPloyas ISM complete.
nWbn alum ia.ia...d me eppvenly ParmLo .: I lxae mirn8 ne e`MgeeMCaulhP rmvbveDM appMcsYr INmMYpn YwnbMewMMnenwcotruconsandarmeet all Mason County design and construction standards,must pay all fees including:
ection fee ith oennR and inspection fee,ant Latecomers cha a rQ12)hard L. Dickinson 2/1323
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Part Mason County Public Health Review/Approval ^ �C^^ ^ �j h�
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This form may be scanned and available for public view on the Mason county Web Site