HomeMy WebLinkAboutBLD Sewer Adequacy - 3/20/2023 •,y<„ 415 N.6TH STREET,BLDG 8,SHELTON WA 98584
6> ��:e• SHELTON:360-427-9870,EXT.400
N� r, MASON COUNTY
ri1 BELFAIR:360-275-4467,EXT.400
; l COMMUNITY SERVICES ELMA:360-482-5269,EXT.400
r`i%r`. ra • Building,Planning,Environmental Health,Community Health FAX:360-427-7798
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 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: 03/20/2023
Mailing Address: 33455 6th Ave S,Unit 1-B City,State,Zip: Federal Way,WA,98003
Site Address: 501 NE Ridge Point Boulevard HSt103 Phone: (253)294-1322 /l
• Parcel Number: 12328-51-00103 Permit Number: B VI Zc,23 - 0D 1.111
Part 2: Sewer System Information
Name of Sewer System: Belfair M Site Plan attached?
Official use only: Sewer System Manager or Designated Employee Is to complete.
0 New Connection. I have reviewed the applicants information and have no issues with Mason County Public Health approving the corresponding
Mason County Permit.
❑ Existing Connection: I have reviewed the applicants Information and have no Issues with Mason County Public Health approving the
corresponding Mason County Permit.
❑ I have reviewed the applicants Information and have determined sewer connection is currently NOT available to this property.
IA Please add the following condition(s)on the corresponding Mason County Permit:(optional)
Must meet all Mason County design and construction standards, must pay all fees
including:c nection fee with permit and inspection fee, and Latecomers charge(TBD).
;----/T.:4
t. • Richard Dickinson 3/29/23
Printed Name of System Managed Employee Signature of System Manager)Employee Date
P 3: Mason County Public Health Review/Approval C�y� (Z J 2 3
Satisfactory ❑ Unsatisfactory I
Signature of Environmental_H lb Specialist
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This form may be scanned and available for public view on the Mason County Web Site.
REVISED 3/212017