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HomeMy WebLinkAboutBLD Sewer Adequacy - 4/4/2023 - 415 N.6TH STREET,BLDG 8,SHELTON WA 98584 MASON COUNTY SHELTON:360-42r-9670,EXT.400 :I!rBELFAIR:360-275-4487,EXT.400 COMMUNITY SERVICES ELMA:360-4825269,EXT.400 71111111.11111.111.11111.11"111111111.1111. ---1' 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: 04/04/2023 Mailing Address: 33455 6th Ave S,Unit 1-B City,State,Zip: Federal Way,WA,98003 Site Address: 411 NE Ridge Point Boulevard Phone: (253)294-1322 11 nn� /� ,�11 Parcel Number: 12328-s1-oat 12 HS 8112 Permit Number: iii OtbT - OD ` l Part 2: Sewer System Information Name of Sewer System: Bctfair [1r Site Plan attached? • Official use only: Sewer System Manager or Designated Employee Is to complete. ©'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. NI/ 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 connection fee with permit and inspection fee,and Latecomers charge(TBD). Richard Dickinson 4/10/23 Printed Name of System Managed Employee Signature of System Managed Employee Date Part 3: Mason County Public Health Review!Approval �� b Cr-1(Z3 [ Satisfactory ❑ Unsatisfactory ( Signatures norvnpn I Hie Specialist8 Date This form may be scanned and available for public view on the Mason County Web Site. REVISED 3/2120t7