HomeMy WebLinkAboutBLD Sewer Adequacy - 4/25/2023 400450
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of apprication. Permit number may be added al 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 mmpleled application and information to Permit Center or Mason County Public Health or review.
NOTE:you must supply the System Manager with a she plain for the project,showing all existing or proposed
sewer components and Bnea in relation ro proposed development and property.
Part 1:Applicant Parcel Information
Applicant Sam Martin,Agent for Lenrl Northwest,Inc Date: 4/25/2023
Mating AddM5: 3305551h AWS.Uniri-B.Fedcd Wry.%W3 City,State,Zip: Federal Way,WA,98003
SlmAldresa: lSt NE Bdfell Sradw Phone: (II3)d -13n n
Parcel Number. n3R-51-00668 Permit Number. UN 2M-00 *
Part 2:Sewer System Information
Name of Sewer System &Bair [a She Plan mached9
OR.J/etat use oMy. Sewer System Manager or Designated Employee K ro complete.
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uv�eapwMbg Masm County Pmnh.
I rwe�eriar.'eE VR epPli siNgma and lure deWrim,e05eMw—aionis Wnenlly NOT amUble b Nk polwly
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Must meet an Mason County design and construction standards must pay all fees
includin :connection fee with verrinit and mrspedon fee and Latecomers chi e CEBD .
Richard Dickinson 514123
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Part 3:Mason County Public Health Review/Approval
satisfactory ❑ unsatisfactory
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This form may be scanned and available for public view on the Mason County Web Site.