HomeMy WebLinkAboutBLD Sewer Adequacy - 7/6/2023 400506
415 N aTH STREET,ai 9.SHELTON VAW—
MASON COUNTY SHELTON:99 iY-9Wo EXr 400
COMMUNITY SERVICES a`L`"R' -15"T'°"4.0
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Application for Determination of Sewer Adequacy
instructions;
1.Complete Part 1 of application. Pemmd 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 ra approval.
3,Submit completed applicator 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
sower components and lines In relation to proposed development and property.
Part 1:Applicant 1 Parcel Information
Applicant Sam Martin,Agent for Under Northwest,Inc Date: 7/6/2023
Mailing Address: 33455 6th Ave S,Unit I-R city,State,Zip: Federal Way,WA,98003
Sireaddrear 291 NE Olympic Ridife prune: (xs3)]9443M
Parcel Number. 12328- 1-00073 Permit Number. 1!fIJ79I2q--(K=
Part 2:Sewer System Information
Name of Sewer System: aedur [g Site Plan ahached9
OmNal use ordy Sewer System Manageror Designated Employee Is M Complete,
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Must meet all Mason County design and Construction standards,must pay all fees
including:connection fee with ennd and inspectionjee,and Latecomers chit a(TBD).
Richard Dickinson 7/13123
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Part 3:Mason County Public Health Review)Approval
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This form may be scanrred and available for public view on the Mason County Web Site.
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