HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400493
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Public Health
Always working for a safer healthier Mason County
415 N.rM Street.ak9 8.Shaw VJA98584
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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 applicatron,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 Perini 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 Nonhest Date: 511&23
Mailing Address: 33455 8th Ave S,Unti CBy,Slate Zip: Federal Way,WA 98D03
Sde Atltlress:
291 NE Belfair Station Phone: 253-294-1322
Parcel Number: 1232851-00035 Permit Number bI.Ma�
Part 2:Sewer System Information
Name of Sewer system: Belfair Sewer District ® Site Plan attached?
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official use onty: Sewer System ManagerorDesignated EmpioyeeistownWi e.
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Must meet all Mason County design and construction standards must pay all fees
including:connection fee with permnit and inspection fee,and Latecomers charge D .
Richard Dickinson - 6129123
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Par�l(]- Mason County Public Health Reviewi Approval
t(�Satisfactory ❑ Unsatisfactory uts
This form may be aeanned and available for public view on the Mason County Web She.
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