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HomeMy WebLinkAboutBLD Sewer Adequacy - 4/4/2023 )`I" 415 N.6TH STREET,BLDG 8,SHELTON WA 98584 �� l,;^!, MASON COUNTY SHELTON:380-427-9870,EXT.400 r `` COMMUNITY SERVICES ©ELFAIR:360.275.4487,EXT.400 r, 'y-� ; ELMA:360-482-5269,EXT.400 ate,^:; ..%. .t`5: 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: 381 NE Ridge Point Boulevard Phone: (253)294-1322 Parcel Number. 12328-51-00115 HS:115 Permit Number: —6 I C 1 .!_t)ZZ _QUA S8 S Part 2: Sewer System Information Name of Sewer System: Bclfair [j Site Plan attached? Official use only: Sewer System Manager or Designated Employee is to complete. 8 New Connection: I have reviewed the applicants information and have no issues with Mason County Public I leatth approving the corresponding Mason County Permit. ❑ Existing Connection: I have reviewed the applicants information end have no Issues with Meson County Public Health approving the corresponding Mason County Permit. 0 I have reviewed the applicants information and have determined sewer connection is currently NOT available to this property. (J Please add the following condltlon(s)on the corresponding Mason County Permit(optional) Must meet all Mason County design and construction standards, must pay all fees includingonnection fee with permit and inspection fee, and Latecomers charge(TBD). \ _ f��- — Richard Dickinson 4/10/23 Printed Name of System Managed Employee Signature d System Managed Employee Dale Part 3: Mason County Public Health Review/Approval Vei/5Satisfactory ElUnsatisfactory Signature irormental Health Specialist This form may be scanned and available for public view on the Mason County Web Site. REVILED 302017