HomeMy WebLinkAboutBLD Sewer Adequacy - 6/15/2023 400468
415 N.6M STREET,KM 5.SHELTON WAS5504
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Application for Determination of Sewer Adequacy
Instructions:
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 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 or proposed
sewer components and line.in relation m proposed development and property.
Part 1:Applicant I Parcel Information
Appiloant Sam Martin,Agent for Lennar Northwest,Inc Date: 6/15/2023
Mailing Address: 33455 6111 Ave S;Unit 1-B city,State,zip: Federal Way,WA,98003
Site Address: 91 NE Ridgetop Crossing Phone: t5])2WlW _
Pamel Number. 12328-51-00024 Permit Number:bU09109q — O
Part 2: Sewer System Information
Name of Sewer Syslelm BdF* [Q Site Plan atladlad7
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e only: Sewer System Manager or Designated Employe&Is to complete.
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l east meet all Mason Coun�rydesign and nstru ton standards must pay all fees
includin : connection fee with Demalt and inspection fee and Latecomers pharcle ).
Richard Dickinson 629/23
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PArt3: Mason County Public Health Reviewl Approval
Satisfactory ❑ Unsatisfactory
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This form may be scarmed and available for public view on the Mason County Web Sita.
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