HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 404-7
MASON coUNT�
PublicHealth
Always working for a safe healthier Masan County
415 N.ath street BMg a,S ii M9a5M
350427-8570 or 39a2]S 7.eodensbn 4W
Application for Determination of Sewer Adequacy
Instructions:1.Complete Pert 1 of application. Permit number may be added at later date.
2.Take application,Site plan,and any other associated information wM 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 protect,showing all exeting or proposed
sewer components and lines In relation to proposed development and property.
Part 1:Applicant/Parcel Information
Applicant: Sam Marlin,Agent for Lennar Norlhest Date: 515123
Mailing Address: 33955 Blh Ave S,Unit 1-B City,State,Zip: Federal Way,WA 98003
Site Address:
221 NE Belfair Station Phone: 253-294-1322
Parcel Number. 12328-514)W 4300.,41 Permit Number. Z02623-OiXAO
Part 2: sewer System Information Lo - y 1
Name of Sewer System: Belfair Sewer District la Site plan attached?
OMclaluseonly: Sewer System Mamgeror Deslgmted Employmisficon*Me.
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Must meet all Mason County design and construction standards, must pay all fees
includin : connection fee with permit and inspeOgs fee and Latecomers cha a BD .
Richard Diddnson / 523Q3
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Part t33: Mason County Public Health Review)Approval
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This form may be scanned and available for public view on the Mason County web Site.
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