HomeMy WebLinkAboutBLD Sewer Adequacy - 6/16/2023 400484
415 N.eTH STREET,El8,Srfansl MOD514,
MASON COUNTY a11ELTON 3e0-IV-861o,E%L 4W
COMMUNITY SERVICES eELFwn:M.40,4laT.EZT4aa
ELrsn aw.Iersxa,Exr.doo
BUIWny,>lanniry,FmeanmeMal NeaXFa.,r.YMeaah FA%:.27-]>ea
Application for Determination of Sewer Adequacy
Indructlons:
1.Complete Part 1 of application Permit number may be added at later date,
2.Take application,Site plan,and any other associated information with Ifw 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 Dare: 6/16/2023
Mating address; 33455 6th Ave S,Unit I-B city,state,zip: Federal Way,WA,98003
Site Address: 360NE0lMpic Ridge plena: CISn"41-1322
'.. Parcel Number. 12328-51-00062 Permit Number:
Part 2:Sewer System Information
Name of S.Syslvm: Balrah [1 Sea Plan attached?
Offklal ase only: Sewer System Manager or Designated Employee is to complete.
Was.coelc2 111se minrol lM epreunb-utlwmelon eN luw,w 4ewe wA Mewn Cwnry PUplic HetlM eIX WIR ale mnn�vlNN
Waon LwMy PemiL
❑ EgWnp cona,.l Iraw rzw.ae npseviss lniormetion and!Mrcm iwuaa wM Meson Coam Public H."ePpovil ae
<wrevPudln9 Ms.L *P—R.
r❑y llcw reNewL tM agJiunla lnro,matlm arE M+e delmnixd wamuvnacUm h oamntlr NOT sisism, Wporary
qa phisnaw lr W,*'mW."4— (M os
Must meet all Mason County design and construction standards,must pay all fees
including:connection fee with permit and inspection fee,and Latecomers charge(TBD).
Richard Dickinson 62923
'.. Pabar,M>sPlnnWgalEmbaa Wavae t5)Nn,MnRnlGMbwa _ne/e (�part 3:Mason County Public Health Review)Approval
G
�'/F�'1 Satistaory ❑ Unsatisfactory
Syulure orE HWU,SrydfM tDaM
Thia form may be scanned and available for public view on the Mason county Web Site.