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Home My WebLink AboutBLD Sewer Adequacy - 5/15/2023 400477 �ASobl Corjv Public Health Always working for a safer healthier Mason County 415 N.Bth Street,Bldg 6,Shelim WA 995a4 360A27-9670 or 36p-2764467,extenabn 400 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 Meant 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 Northest 5115/23 Date: McNing Address: 33455 sth Ave S.UM 1-B City,Stale,Zip: Federal Way,WA 98003 Site Address: 281 NE Belfeir Station Phone: 253-294-1322 Parcel Number.. 12328-51-00036 Permit Number I JLr,�2029 Part 2: Sewer System Information Name of Sewer System: Belfair Sewer District Ir7 Site Plan alladled7 OlBelal user only. Sewer System Manager orossignated Employee Is m complete. ® New Gnneclbn: IMve mMewea Ne applirana lnfameaonaM lave mksuea wiN Masco Oaaay PWbc HeelN epprwirp lee mneapontlln9 Maven County PanneL -mewedam Ms.Coen y Peron Ne eppacems iNpmaYM erW heW m isq,pawiN Magn Cwnry Public Healle aPPrwi�lg Ne mmespolWirq Meech Canty PttML ❑ IMW rovevral one aXeCanly inMmanon anal Mve daker meaaMlrcomiectin u o rsnar NOT avelkOk k,Mis prp " ® Pleaw eda Ne rerw4M oxeliGon(emu»mlieepa lilq Moen GCUMy PaMt(pplbmala Must meet all Mason County design and construction standards must nay all fees including: connection fee with permit and inspection fee, and Latecomers charge (TBD). Richard Dickinson 61t723 R Weme d$yry Mnpv/Eniploaw 9lapheetl Syelpni MCMpv/EnpgAe eye Part 3: Mason County Public Health Review/Approval Ipl Satisfactory ❑ Unsatisfactory Sgnelure q arN nwrrl an apede11. ^k r �M IJO This form may be scanned and available for public view on the Mason County Web Site.