HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400464
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Publicil Health
Always working for a safer healthier Mason County .
415 N.elh Sbeel,Bldg 6.Sualon Mall 4
3 127-9670 or 380-275-4467,exlenslon 400
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of application. Permit number maybe added at 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 to proposed development and property.
Part 1:Applicant I Parcel Information
Applicant. Sam Martin,Agent for Lennar Nonhest Data 515123
Mailing Address: 33455 81h Ave S,Unit 1-B City,State,ZIP Federal Way.WA 08M
Site Address: 131NERidgetap Crossing Phone: 253-294-13�22
Parcel Number. 12328500 1- 020 Permit Number BId VM.vt?7'DI%ice
Part 2: Sewer System Information
Name of Sewer System: Belfalr Sewer District ® Sib Plan attached?
official use only: Sewer System Manager or Designated Employee Is to complete.
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Must meet all Mason County design and construction standards, must pay all fees
including:connect lOrl fee with permit and inspection fee and Latecomers charge(TBD).
Richard Dickinson 611223
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Par 7:Mason County Public Health Reviewl Approval ( /I
Satisfactory ❑ Unsatisfactory
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This form may be scanned and available for public view on the Mason County Web Site.
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