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Home My WebLink AboutBLD Sewer Adequacy - 5/15/2023 400476 415 N.8TH STREET,ILOG 8,SHELTON WA98584 MASON COUNTY SHELTON:380.427-9670,EXT.400 er94117 .' COMMUNITY SERVICES BELFAIR:360-275-4467,EXT.400 ELMA:380-482-5269,EXT.400 Building.Planning,Environmental Health,Community Health FAX 360-427-7798 Application for Determination of Sewer Adequacy Instructions: Lic4 2-P-1 1.Complete Part 1 of application. Permit number may be added at later date. 2.Take application,Site plan,and arty 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: 191 NE Belfair Station Phone: (253)294-1322 Parcel Number: 12328 51 4944 DICb`� Permit Number: ?)lel 2625• O 110 3 Part 2: Sewer System Information Name of Sewer System: Belfair Water District I21 Site Plan attached? Official use only: Sewer System Manager or Designated Employee is to complete. V 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. Please add the following conditlon(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 Latecomers charge(TBD). Richard Dickinson - 5/23/23 Printed Name cf System Managed Employee Signature of System Managed Employee Date Part 3: Mason County Public Health Review/Approval I �I�� Satisfactory ❑ Unsatisfactoryrt- I Signature of Environmental H Ith Specialist D .4 c This form may be scanned and available for public view on the Mason County Web Site. REVISED 3/2/2017