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HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400459 90N CQDU - 1I 1, Publicofoii , Health Always working for a saferhealthier Mason County 415 N.6th Street,Bldg 8,Shelton WA 98584 360-427-9670 or 360-275-4467,extension 400 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 Northest Date: 5/15/23 , Mailing Address: 33455 6th Ave S,Unit 1-B State,Zip: Federal Way,WA 98003 140 NE Ridgetop CrossingPhone: 253-294-1322 Site Address: 9 p Parcel Number: 12328-51-0015 Permit Number: (d ? ZZ '()Obi Part 2: Sewer System Information Name of Sewer System: Belfair Sewer District 0 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 0 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 fear nd Latecomers charge(TBD). Richard Dickinson V(/' .-__ 5/23/23 Punted Name of System Manager!Employee Signature of System Managed Employee Date Part : Mason County Public Health Review!Approval C^ I t. /�-� Satisfactory ❑ Unsatisfactory d►� l Signature of Environmg tal Health Speciali t Date tlAn j -1 This form may be scanned and available for public view on the Mason County Web Site. REVISED 10282015