HomeMy WebLinkAboutBLD Sewer Adequacy - 3/20/2023 �ASoN COvv
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Public Health
AWays working for a safer healthier Mason County
415 N.61h SNeal,Bldg 8,Sheaan WA98584
360437-8670 or 360-275J 67,extension 400
Application for Determination of Sewer Adequacy n
Instructions: �� V
1.Complete Part 1 of application. Permit number may be added at later date.
2.Take application,Site plan,and any other associated information with the proposed development ro the Sewer
System Manager or Designated Employee for approval.
3.Submit completed application and information to Permit Center or Mason County Public Heats for review.
NOTE:you must supply the System Manager with a site plan for fire protect,showing all existing or proposed
sewer component and lines in relation to proposed development and property.
Part 1:Applicant I Parcel Information
Applicant Sam Martin,Agent for Lennar Northwest, INc Dare: 3/2 012 0 2 3
Meiling Address: 33455 5th Ave S, Unit 1-B City,State,Zip: Federal Way,WA 980M
Site Address: 521 NE Ridge Point Boulevard Phone: 253 294-1322
Parcel Number. 12328-51-00101 HS#101 Permit Number: 'tM;�b23-fnl
Part 2:Sewer System Information
Name of Sewer System: Betfair ® Site Plan attached?
OgkJafussonly: 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: connection fee with permit and inspectiogritee,and Latecomers charge(TBD).
Richard Dickinson 6223
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Part :Mason County Public Health Review/Approval
Satisfactory ❑ Unsatisfactory
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This form may be scanned and available for public vl�ew on fire\�Mason County Web SSiCtah