The URL can be used to link to this page

Home My WebLink AboutBLD2022-00881 Lot 123 - BLD Sewer Adequacy - 2/9/2023 Acct# 400423 .15 N.STH STREE[BLOC 8,SHELTON eMB MASON COUNTY SHELTON:380.427tl8rO,ET.400 COMMUNITY SERVICES BIEUNR 3SSV5 HV.E`T'°" ELMA:3a0.M2 .EXT.ba aiMdna[4nbyEm—u'Rule,rn«nnNyhea.h FAX M0.1n-T)w Application for Determination of Sewer Adequacy Instruction.: t.Complete Part 1 of application. Permit 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 fi form dicn to Permit Center or Mason County Public Hearth for review. NOTE:You must supply the System Manager with a of plan for the pmjsct,showing all existing or proposed sewer components and lines In nuadon W proposed development and property. Part 1:Applicant Parcel Information Applicant Sam Martin,Agent for 1&nnar Northwest,Inc Date: 02/09/2023 Mailing Atidmss: 33455 6th Ave S,Unit 1-B city,suds,ZJp: Federal Way,WA,98003 Site Addrea.: 91 NEBeVW sntbn'Addw abject[0 rhange• Phone: (n3)M4-1323, PercelNunber. 1232°"21"°°°°o:wsse.aw,w°°°t«e^rtwrsb Pmmll Number:�l�t /��2— /]r)�� Part 2:Sewer System Information L,pi- 1a3-6lcyty,Fu�l�idaQ) Name of Sewer System: Bal IN She Pien Bpacflad4 Oale/al use only: Sower Sysmm Managaror Designated Empbyee/s to compMM IB M.M county oP bow nrvbwe8ge appeanb NtlmmMknaN nmminwewro Ma.encwnh Punk Hann«pwlro l«ca,.monenp M. PerML ❑ ......(.a,Man: Ih 1,e 'I the eaficenb Mlamtllwia««wwlmuesww M«nnCwMy Pudk NatlP eplxwwe ee mreaPon40 Meson County PBmJI. ❑ Ihwe le,avai Me ar fica.lnblmeam and haw came. .ae«r—sm,n htunemy NET awkwis Is MI. ralay ® PMvw M1 ca ax M —de-(., Mew+ewMY PaML WacceJ Must meet all Mason County design and construction alaMmds,must pay A fees including: connection fee whh permk and inspection fee,and Latecomers charge FEE). Richard L.Dickinson 2113/23 Pwwx.n,easwrn M..ew Enpey.. Newn•wsra«Mnes«anrbwe om Part t3:Mason County Public Health Review/Approval ` / kZy5atiafecbry El Unsatisfactory J� / serum:U r«na «IN t .«.-IIW�A�L__ qb This form may be scanned and available for public visa on the Mason County Web Site.