HomeMy WebLinkAboutBLD Sewer Adequacy - 6/16/2023 400483
415 N.aTH STREET,BLDG B.SHELTON MMSSW
MASON COUNTY s"IXTON1980 7T ? IXT'°°
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Application for Determination of Sewer Adequacy
InsWctlone:
i.Complete Pan 1 of application. Permit number may de added at later date.
2.Take spplioal Site plan,and any other assoclaled Inhernalion with the proposed development to the Sewer
System Manager or Oesignaled Employee For approval.
3.Submit completed application and Information to Permit Center or Mason County Public Health for review.
NOTE:You must supply rho System Manger with a site plan for the project,alarming all existing or proposed
sewer components and lines in relation W proposed development and property.
Part 1:Applicant Parcel Information
Applicant: Sam Martin,Agent for termer Northwest,Inc Deal: 6/16/2023
Mai ng Address: 33455 6th Ave S,Unit I-B City,state,zip: Federal Way,WA,98003
sdeAddeass: 350 NE Olympic Ridge Phma: (35a)ID -laic
Parcel Number: 12328-51-00061 parma NumIxr Rll��n -00043
Part 2:Sewer System Information
Name of Sewer Sysem: a l to Site Plan alladwd?
Olffca, use oniy: Sewer Sysfem Atanwer or Desigmrt d EmPloyee fs w compkte.
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Must meet all Mason Counts design and Construction standards must pay all fees
=indulne with permit and in fee nd Latecomers charge SD).
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PMason County Public Health Review!Approval
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This form may be scanned and availablefor public view on the Masson County Web Sil
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