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Home My WebLink AboutBLD Sewer Adequacy - 5/15/2023 ' . 400 Zt'767 415 N.6TH STREET,BLDG 8,SHELTON WA 98584 MASON COUNTY SHELTON:360-427-9670,EXT.400 �` ii COMMUNITY SERVICES BELFAIR:360-275-4467,EXT.400 ELMA:360-482-5269,EXT.400 Building,Planning,Environmental Health,Community Health FAX:300-427-7798 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: 5/15/2023 Mailing Address: 33455 6th Ave S,Unit 1-B City,State,Zip: Federal Way,WA,98003 Site Address: 201 NE Belfair Station Phone: (253)294.1322 Parcel Number: 12328-51 obo-. 2 Permit Number. ?Did 2)23 • 41151 Part 2: Sewer System Information Name of Sewer System: Belfair Water District Site Plan attached? Official use only: Sewer System Manager or Designated Employee is to complete. Fic New Connection: I have reviewed the applicants information and have no issues with Mason County Public Health approving the corresponding Mason County Permit. O Existing Connection: I have reviewed the applicants Information and have no issues with Mason Courtly Public Health approving the corresponding Mason County Permit. ❑ I have reviewed the applicants information and have determined sewer connection is currently NOT avai:able to this property. Ne 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 fee,an atecomers charge(TBD). /�iRichard Dickinson V Cr.: 5/23123 Printed Name of System Manager/Employee Signature of System Manager/Employee Date Part 3: Mason County Public Health Review/Approval ' NS 1C7i7j--2/� Satisfactory ❑ Unsatisfactory / Signature of Environmental He Ith peciaiist ale This form may be scanned and available for public view on the Mason County Web Site. REVISED 3/2/2017