HomeMy WebLinkAboutBLD Sewer Adequacy - 7/6/2023 400501
415 N.eTH Smill A W e,S M.TON wAsab1
MASON
SON COUNTY
SHELTOW 910427-1 FM.400
LFAIR:COMMUNITY SERVICES aEEiSW'ns 96040] E%T400
ELAN -5 i&e,IXT 400
9WWI,p,W,iNgEnvYvnwnW XnllRComminI,IHWIn FM,96 27.7799
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part i of application Permit number maybe added at Wier dale.
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 Lerner Northwest,Inc Dale: 7/6/2023
Mai Address: 334551 Ave S,Unit 1-13 city,State,zip: Federal Way,WA,98003
She Addrie s: 341 NE Olympic Ridge Phone:
Parcei Number. 12328-51-00068 Permit N ben oil IJR�fJI. -oU0 R
Part 2:Sewer System Information
Name of Sewer System: Betty Ig She Plan selected?
OHicratmeonry, Sewer System Nanageror Designated EmptoyNf$Mcompfefe.
"err Cmnafiae l nave nvbM V lM1e.gA'+nk lNamurm ant loco ne bow wiNMaxn Cumry Putlic Healln eipNvtp UMoarealW,p
',. MaMn Ceu,M'Parrol.
En�,q Cnnnerdan: Itlee mnwnO Ne appYcenb lnl0lmstlm anO MverolnweswM MxmiCwnlY l'ud2 H¢eM eppmrinB Ole
wr¢epoMlrq Maps County Panntt.
❑ I nvw eevbwetl ,s aGPrw,Aa lNmmatlm a ,wdsssi M sever a rsi is cumirw Nm avascie W mh PmWa..
IZ Pww ma as oulon*e mala�N^^nv,*r,aspwWis Mason ceuM."orsy
Must meet II Maso County design and construction standards must pay all fees
including:connection fee with permit and Inspection fee,and Latecomers charge(TBD).
Richard Dickinson 7/t3/23
RMWMMdSYMnMtrnYMEmNgw SV`+'web SYpm MwoplErtMlwa ass
Part 3:Mason County Public Health Review/Approval per_ __ _ ���
Satisfactory ❑ Unsatisfactory N ��It� 1r�f
sgaM9b otAEml, _ ,�al��Pw'.pµ p fj Dare
This form may be scanned and available for public view on the Mason County.County Web Site pjd�