HomeMy WebLinkAboutBLD2022-00868 Lot 97 - BLD Sewer Adequacy - 2/9/2023 Acct 4 400427
415 N.aTH STRL£T,BUDG 8,M&TON W iahi
MASON COUNTY WELVOW.89p ar E%T.480
COMMUNITY SERVICES GEFNR:e®Zrs48TEX7r.400
a.MA:a9oweL5]ea,M 400
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Application for Determination of Sewer Adequacy ,, 1
LD4 Instruction.: cl-7�
1.Complete Part 1 of application. Permit number may be added at later data
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 slte plan for the protect,showing all existing or proposed
sewer components and lines In relation to proposed development and property.
Part 1:ApplicantI Parcel Information
Applicant Sam Marlin,Agent for LennaT Northwest,Inc Date: 02/09/2023
Maaing Address: 33455 6th Ave S,Unit I-B Citg Stale,zip: Federal Way,WA,98003
Site Address: 31NE0lp ncRldge*AddrmeubtectbcbmSe phone; (253)994�1393
Parcel Numpenl2m-fl-eeee(k im,ne snn, Permit Numben�d *9052,2^ QrJ plpp
Part 2:Sewer System Information
Name of Sevvir System: Belud, ® Site Plan agaMed?
Off/elalweonly: Sewer System ManagerorD"IgmWEmpfoy.skMComplete.
19 New ON1.11m: Ihave n:Ncwed the ap1Piki blamelbneM he..lnueaxiN Wr Q.*P.M.HeaMappoNnp Nawneepentling
Moon County P.1,
❑ torleg Conroy-: lhawiml maryFnbinr wn"hawnitlewawNh Meem Cwnry PuNc HmMe�tin
mna,rPe pMe.county Perm,
❑ Ilam oxAewd"Npbma Nwnutlm and have derermMtlew.ermnneoxvi m oun of NOT"iew b Mew m,,
® PYaa.Ma M4Wrq cvg .)on uw—iso`olne l.Yaon Cwnry Pen,a:(apa,ng
Must meet all Mason County design and construction standards,must pay all fees including:
connection fare with permit and inspection fee,and latecomers charge(TBD).
Richard L.Dickinson :_ 2/1323
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Pa�rt/3�: Mason County Public Health Review/Approval
mishmary ❑ Unsatisfactory
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This form may be scanned and available for public view on the Mason County Web She.
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