HomeMy WebLinkAboutBLD Sewer Adequacy - 7/6/2023 400498
MASON
(� T�'r COUNTY
415 N.aTH STREET.GU)G S.SHELTON WA90W
MASON COUN 1 1 S ELMN:a60.427-900,FM 400
COMMUNITY SERVICES 6EEJAA,ISAffli 9Pnvl) saT,IXT400
ELM4 3ania?SZB9,IXT.400
9dYMp wyesn—n lHnak Community Health FAX:3&c427-1796
Application for Determination of Sewer Adequacy
InsmlctlOne:
1,Complete Pan 1 of appl,,esm. Permit number may be added at later date.
2.Take awlicalion,Site plan,and any other associated inbrnatlon with the proposed development in the Sewer
System Manager or Designated Bnploye s for approval,
3.Submit completed application and information to Permit Center or Mason County Public Heath for review.
NOTE:you .at supply the System Manager with a site plan for the project.showing all existing or proposed
sewer components and lines in mlatlon to proposed development and property.
Part 1:Applicant Parcel Information
Applicant Sam Martin,Agent for Lennar Northwest,Inc Date: 7/6/2023
Mailing Address: 33455 6th Ave S,Unit 1-B City,State,zip: Federal Way,WA,98003
site Address: 330 NB Olympic Ridge phone (253)29t-13M
Pamel Number 12328-51-00059 Permb Number. RIII.r10 '-00
Part 2:Sewer System Information
Name of Sewer System: &ttw'. v[j Site Plan attached?
oitkaluseonly: Sewer System Manager or Designated Employee Is to complete.
a rvlaUbn:lhaVe iaviwmEda elpkenle tnlw�mlin wM new ra i..umwM�uuon Cowley Pudc Helen eppmAlq Uw<9r1eY ^n
W.Cwmlr Peme.
❑ EdW'mC.mxnaMr. lMve reuiewM Me enp6aMs Mwmatlon vet Mw rolevxawMl Mevn GanHP d'w HealA RParaN eye
wn ,xnone M.p cauMy Pe-n
❑ IMVe rtviwrealM appmm�le lMmma4m eM tare 9¢Ie�Mma en:wmve[timu¢nleny NOT mileGe e.h, apah'.
P1wm a1tl Ina INunnOcwNNMItIm tle mveWadlM aLeon cw9Y Pmml[W➢a31n0
Must meet all Masco County design and curnamction standards must pay all fees
inoludin :connection tee with perrnft and ins ion and Latecomers charge SD .
Richard Dickinson - 7/13/23
d MarISPnae+eWaYEaeMae 5'eWeaayemn MwJ}IBNhi� �°
Par(rtt 3:Mason County Public Health Rerviewf Approval
t[{ Satisfactory ❑ Unsatistadwy IN
I Iseult,a �'r
This form may be scanned and available for public view on the Mason County web Site.
Imi®amen,