HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400481
MASON C0 (jNT�'
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PublicTwHehalth
Always working for a safer healthier Mason County
415 N.61h Street Bldg 9.Shelton WA 0111
M0427-9670 or 360-E25-4467,extension 40D
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part i of application. Permit number may be 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 Normest Date: 5/1523
Mailing Address: 33455 6m Ave S,UMt 1-B Cify,State,Zip: Fed"Way.WA 98003
Site Address: 231 NE Belfair Station Phone: 253-294-1322
Parcel Number: 1232"1-00040 Permit Number: Id 2023. 0130(0
Part 2:Sewer System Information
Name of Sewer System: Belfair Sewer District
® Site Plan attached?
Official use only: SawsrSyafem Manager"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 inspection fee,and Latecomers charge(TBD).
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Part 3: Mason County Public Health Reviewl Approval
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This form may be scanned and available for public view on the Mason County Web Site.
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