HomeMy WebLinkAboutBLD CD Environmental Health Review - 5/15/2023 400462
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PublicHealth
Always wonting for a safi�r—&healthier Mason Count,
415 N.61h Street,Bldg 6.Shemn WA W584
36D427-9670 or 360-VI 167,exterior 400
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of application. Permit number may be added M 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 lines In relation W proposed development and property.
Part 1:Applicant I Parcel Information
Applicant Sam Martin,Agent for Lennar Northesl Date. 5115R3
Mailing Address 334S5 Sth Ave S,Unit 1-B City, Stale Zip: Eedeml Way,WA 9e003
Site Address: 151NERidgetop Crossing Phone: 253-29a1322
Parcel Number: 12328-514644e A 19I Permit Number. ?>Id ZD2.3• �I ."l25
Part 2: Sewer System Information L.D-F IS
Name of Sewer System: Belfair Sewer District ® Site Plan attached?
ORlclal us r oMy: Sewer System Manageror Oesfgmhtl Employee is W complNe.
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Must meet all Mason County design and construction standards must pay all fees
including: wnnedioIT fee with permit and ins ction fee, and latecomers charge (TBD).
Richard Dickinson 52323
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Part3:Mason County Public Health Review/Approval
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This form may be scanned and available for public view on the Moon County Web Sib.
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