HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 40641+
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Public < Health
Always worbrg for a safer healthier Mason Cmmly
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WO-421-9010 or 3 225-0452,extension Opp
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of application. Peril number may be added at later date.
2.Take application,She 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 to proposed development and property.
Part 1:Applicant I Parcel Information
Applicant: Sam Martin,Agent for Lennar Normest Crew. 5/15123
Mailing Address: 33455 BM Ave S,Unft 1-B Cfty Slate 2b: Federal Way,WA 98003
She Addr,w 211 NE Be9ab Station Phone: 253-294-1322
Parcel Number: 123285140Q i)AA'Aa PennHNumber: s )02A1,2Z -(,DP51I
Part 2:Sewer System Information L 6+ N a
Name of Sewer System: Belfair Sewer District ® Site Plan attached?
official use oMy: Sewer System Manager or Designated Employee is M complete.
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Must meet all Mason County design and Construction standards,must pay all fees
including: Connection fee with permit and inspection and Latecomers charge D .
Richard Dickinson /��}— 5/2323
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Part
3s: Mason County Public Health Review/Approval � "C91/1 00 IV7)factory ❑ Unsatisfactory
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This form may be scanned and available for public view on the Mason County web She.