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Home My WebLink AboutBLD Sewer Adequacy - 4/4/2023 415 N.6TH STREET,BLDG 8,SHELTON WA 98584 SHELTON:380-427-9870,EXT.400 L :', MASON COUNTY BELFAIR:360-275-4467,EXT.400 °? COMMUNITY SERVICES ELMA:3600482-5269,EXT.400 ::.; FAX 360-427-7798 <:''..- ;' Building,Planning,Environmental Health,Community Health 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 I 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 Phone: (253)294-1322 • Site Address: 431 NE Ridge Point Boulevard �7 22 1 12328-51-00110 fi$sI10 Permit Number: l�l 2 O r p Parcel Number: lU.I— I O Part 2: Sewer System Information [v7 Site Plan attached? Name of Sewer System: Belfair Official use only: Sewer System Manager or Designated Employee Is to complete. Va'Now 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. qPlease add the following condition(s)on the corresponding Mason County Permit(optional) Must meet all Mason Count desi n and construction standards must a II f s includingi-connection fee with permit and inspection fee,and Latecomers charge(TBD). Al " 4/10/23 :� Richard Dickinson Sipraiure ei System Manager!Employee Dale Primed Name d System Manager!Employee Part 3:Mason County Public Health Review!Approval � �nn'� � ��J3 Satisfactory ❑ Unsatisfactory Signature of Environmenlyl alH to sllist Date c6 ( This form may be scanned and available for public view on the Mason County Web Site. sEo 34/20,7