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HomeMy WebLinkAboutBLD Sewer Adequacy - 7/17/2023 (6 LO a oa3 oO&&7 ENVIRONMENTAL HEALTH .�SoN cotr �. Public1 Health RECEIVED Always working for a safer 6 healthier Mason County 415 N.6th Street,Bldg 8,Shelton WA98584 JUL 1 7 2023 360-427-9670 or 360-275-4467,extension 400 '',1 r ".a Alder Street 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: Ethan GillmingIJared Baehmer Date: Mailing Address: 2102 East Main Suite 105 City, State,Zip: Puyallup,WA 98372 Site Address: 2610 E Slate Route 302,Bellair,WA Phone: 866.657.4371 Parcel Number: 1221e2400040 Permit Number: Part 2: Sewer System Information Name of Sewer System: 0 Site Plan attached? Official use only: Sewer System Manager or Designated Employee is to complete. wNew 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. ill Please add the following condition(s)on the corresponding Mason County Permit:(optional) � /Ac: &40F,7 y LQ6R�tf�.,S /i41ei/V f s G N L'ice dt.t&cc) / ( p3/3v/.2a.23 Printed Name of System Manager/Employee Signature of System Manager/Employee Date Part 3: Mason County Public Health Revievtlr Pr 1 /7 7/��`W Satisfactory ❑ /Unsatisfactory t -11 ` !� 'at'#' vi'onmental Health Specialist Date This form may be scanned anifiQabitatIpAtfor public aidon the Mason County Web Site. w ww ENV REVISED 10/28/2015 iRONME DJq 4444 8A4,