HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 (2) 400463
OoON COUNT
Public` Health
Always working for a safer healthier Mason County
415 N.sih Steel.Bldg 8,Shelton WA 98584
360427-9670 or 360-275-4467,extension 400
Application for Determination of Sewer Adequacy
Instructions: L4
1.Complete Part i of application. Permit number may be added at later date.
2.Take application,Site plan,and any other associated inbnnation 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 Lenner Northesl Date: 5115/23
Mailing Address: 33455 61h Ave S,Un81-e City.State,Zip: Federal Way,WA 98003
Site Address: 141 NE Ridgelop Crossing Phone: ^253-294-1322
Parcel Number: 12328-61-OD019 Permit Number. VI4 aoaa - WV
Part 2: Sewer System Information
Name of Sewer System: Belfair Sewer District ® Site Plan aaaclled9
Oglclal use only: Sewer System Manager or Oesigersfed Employee Is to 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 fee,and Latecomers charge(TBD).
Richard Dickinson 6/1223
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Part 3: Mason County Public Health Review/Approval 1 �I�6
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This form may be scanned and available for public view on the Mason County Web Site.
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