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Home My WebLink AboutBLD Sewer Adequacy - 5/15/2023 400458 415 N.8TH STREET,BLDG 8,SHELTON WA 98584 . MASON COUNTY SHELTON:360-427-9670,EXT.400 i I `1 l BELFAIR:360-275-4467,EXT.400 -` : COMMUNITY SERVICES ELMA:360462-5269,EXT.400 Building,Manning,Environmental Health,Community Health FAX:360-427-7798 Application for Determination of Sewer Adequacy Instructions: b I p.{c� idle) Lcf I-7 1.Complete Part 1 of application. Permit rtanber 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: 190 NE Belfair Station Phone: (253)294-1322 Parcel Number: 12328 51 0014 Permit Number: B I d 2,023'D 1102 Part 2: Sewer System Information Name of Sewer System: Belfair Water District lit Site Plan attached? Official use only: Sewer System Manager or Designated Employee Is to complete. g New 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 Ed Please add the following conditton(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, and Latecomers charge(TBD). Richard Dickinson ��• 5/23/23 J Printed Name of System Manager/Employee Signature of System Managed Employee Date Part 3: Mason County Public Health Review/Approval 7 ' Satisfactory ❑ Unsatisfactory Pry W1 ClI( LV -- Signature of I� tat e`h�Specialist 4 This form may be scanned and available for public view on the Mason County Web Site. \J` REVISED 31213017