HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400480
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Public !Health
Always working for a safer he Mason County
415 N.BUT Sued,Bldg e,Shelton WA 98564
360427-9670 or 360-276i 167,od.nMoa 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 wim 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 calm a site plan for the protect,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 Northesl Date. 5115123
Mailing Address: 334558111 Ave S.Unit 1-B City,stale,Zip: Federal Way,WA 9W03
Site Addmas: 251 NE Belle,Station Phone: 253-294-1322 L
Parcel Number: 12328-51-00039 perms Number: L
Part 2: Sewer System Information
Name of sewer System: Belfair Sewer District ® Site Plan attached?
Olgcialussonly: Sewer System Maeagsror Oeslgrmfed Employsfistocomplem.
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® Please led aw roewin9cpY1NJ,1(Sl on ve caredpanda,Mason coast,PemIX:(eph000l)
Must meet all Mason County design and construction standards must pay all fees
including: connection fee with permit and inspectiori4eall and Latecomers charge (TBD).
Richard Dickinson — BH223
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Part 3: Mason County Public Health Review/Approval h
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This form may be scanned and available for public view on the Mason County Web Site.
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