HomeMy WebLinkAboutBLD CD Environmental Health Review - 4/25/2023 400454
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Application for Determination of Sewer Adequacy
Instructions:
I.Complete Pan 1 of application. Permit number may be added at later date.
2.Take appliwtlon,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 alta plan for the profec%showing all existing or proposed
sewer components and lines In relation to proposed devalopment and properly.
Part 1:Applicant Parcel Information
Applicant Sam Martin,Agent for Lennar Northwest,Inc Dam: 4/25/2023
Melling Address: 3M556d,Aw$.11utl-g,Fnhmd Wa N0W city,state,zip: Federal Way,WA,98003
Sim Address: V1Ne11e1faa Sumon Phone: (Vu)fl4--1322
Parcel Number. 123ra-sr-sma6 Pal Number. (/i�/�7
Part 2:Sewer System Information
Name of Sewer System: Begdr ® Sim Plan seemed?
Offn/claluaeonty: Sower System Manetieror Designated EmployealsmeonWtM.
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Must meet all Mason County design and construction standards, must pay all fees
including:connection with permit and huipel laill.and Latmintil cha a CTBD
Richard Dickinson 514/23
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P rt 3:Mason County Public Health Review/Approval Satisfactory ❑ Unsatisfactory Sgn � I,LI L�
coa This form may be scanned and available for public view on the Mason County Web Site