HomeMy WebLinkAboutBLD Sewer Adequacy - 4/25/2023 400456
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pan 1 of applicalon. Permit number may be added at later deal
2.Take application,Site plan,and any other associated information with the proposed development to Me Sewer
System Manager or Designated!Employee for approval.
3.Submit completed application and information to Peal Center or Mason County Public HeaIM for review.
NOTE:You must supply Me System Manager with a she plan for the project,showing all existing or proposed
sewer components and lines In relation b proposed development and properly.
Part 1:Applicant I Parcel Information
Applicant Sam Martin,Agent for Lerner Northwest,Inc Date: 4/25/2023
Manbg Addrew: s>rss ah Aws,uea l-a paaa.d w.µ aBoa3 CRY,State,Zip: Federal Way,WA,98003
Sile Address. MONE RWgc Poin[BoamEd Phone: 0153)M-13=
Parcel Number. hilt-5140139 Permit NumbeL ��l/OLU�
Part 2:Sarar System Information
Nameof Sewer System: edmeb [Z Site Plan allowed?
Olicleassonly: Seger Sysem Manageror Designated Employealstoepnrylara.
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Must meet all Mason Co my design and construction standards must pay all fees
Including: connection fee with small and ins ction film and latecomers cha a
Richard Dickinson - 5/4/23
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Party Mason County Public Health Review/Approval
atialeacry ❑ Unsatisfactory
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This form may be scanned and available for public vlew on the Mason CourtlyWebt She...