HomeMy WebLinkAboutBLD Sewer Adequacy - 7/25/2023 400509
415 N.STH STREET,B=a,SHELTON MM ONSA
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COMMUNITY SERVICES BEEWA;LFAVR:35E,102-Me.M.EXT.400
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Application for Determination of Sewer Adequacy
Instructions:
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 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 W proposed development and property.
Part 1:Applicant/Parcel Information
Applicant: Sam Martin,Agent for I.ennar Northwest,Inc Dab: 7/25/2023
Mailing Address: 33455 6th Ave S,Unit 1-B City,State,Zip: Federal Way,WA,98003
Site Address: 240NEOlymplc Rudxc _ phone: (20)2%-1322
Parcel Number. 123E8-51-OW52 Permit Number. R��aL{—nnl5e2
Part 2: Sewer System Information
Name of Sewer System: adfdu f$ Sib Plan attached?
o lelai use only: Sewer System Manager or Designated Employee is to complete.
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Mean County Paint
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mueepandim Mean Ccuny Paint
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Qr R.e,,ft IoanAnO rind .)on the rare ding Mann Ccuay Permit f1 Men
Must meet all Mason County design and construction standards must pay all fees
inclutlin :connection fee with pentilit and inspection fe Latecomers charge TBD .
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Richard Dickinson $14123
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Part,3:Mason County Public Health Review!Approval �l'�-h
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This form may be sunned and available for public view on the Mason County Web Site.
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