HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400460
PubliCL .l 'Health
Always working for a safer • healthier Mason County
415 N.6th Street,Bldg 8,Shelton WA 98584
360-427-9670 or 360-275-4467,extension 40D
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 Northest Date: 5/15/23
Mailing Address: 33455 6th Ave S, Unit 1-B City, State,Zip: Federal Way,WA 98003
Site Address: 150 NE Ridgetop Crossing I I Phone: 253 294-1322
Parcel Number: 12328-51-0016 !Ot Permit Number: 'BidI pSQ9 • Ubek3t)
Part 2: Sewer System Information
Name of Sewer System: Belfair Sewer District ® Site Plan attached?
Official use only: Sewer System Manager or Designated Employee is to complete.
® Net,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.
® 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 ¶ and Latecomers charge (TBD).
Richard Dickinson /;_ _ " --- ---.-- - 5/23/23
/
Printed Name of System Manager/Employee Signature of System Manager/Employee Dale
Part : Mason County Public Health Review/Approval c,,� ��� -3
Satisfactory El Unsatisfactory r, ,
Signature of Environ ntkHealth Specialist e
This form may be scanned and available for public view on the Mason County Web Site.
REVISED 1028/2015