HomeMy WebLinkAboutBLD Sewer Adequacy - 6/16/2023 400496
415 N.61H STREET,aLDS 9,SHELTON VMB95&
MASON COUNTY SHELTON:9ae4N-9We,EXT.400
COMMUNITY SERVICES SELFNIR:W 276Mar,ExT 400
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pad 1 of application. Permit number 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 of proposed
sewer components and lines in relation W proposed development and property.
Part 1:Applicant Parcel Information
Applicant Sam Martin,Agent for Lennar Northwest,Inc oats: 6/16/2023
Meiling Address: 33455 6th Ave S,Unit 1-B City,Stets,Zip: Federal Way,WA,98003
Sile Address: 351 NF 01)zmpir Ridge Phone: (253)29411y3n
Parcel Number. 12328-51-00067 Permit Number.
Part 2: Sewer System Information
Name of Sms Sy vmr &1hur [v7 Site Plan attached?
Official use oMy: Sewer System Manager or DesfgnaW Employee Is Is complete
ly Now CmnNimr I Now re*mmh,e al9rrmlaiNmnWm am Mre m ixeues wig,Mason C Iy Pudro HeNth epese,im the wnemwndy
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❑ IhM ieVieaN Cx appllrar,IS MIm1atlm aM now MMmYnel sewwmwctio-,'n wnMN NOTaradaaMro Nk prope,y
�n»ae am ua aewa,9 mmaaM•1 m wa cireepvEaa sown oamav Permit laprMw)
Must meet all Mason County design and wristruglign standards must I fees
includin :connection ewithriennitandins RWIM fee tecorners chorale BD .
Richard Dickinson 6/2923
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!..,.,. Past 3:Mason County Public Health Review/Approval ` /
rL-Sa[`Sabsfactory ❑ Unsatisfactory p t J LI
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'.. The form may be scanned and available for public view on the Mason County Web Site.