HomeMy WebLinkAboutBLD Sewer Adequacy - 11/7/2023 400470
115 N.BTN 11EET,aLDG a,aHELTON Mvia"
sNELrON:a -V-ero,M,Soo
MASON COUNTY
eELran:srmvvr,Exr xoo
COMMUNITY SERVICES E,a aap. -sme.ExT ens
.10, wu
BLg.Hmnlrg En�ia,meNN mimuNry Me FAX
Wtl J6D4R-Ta9
Application for Determination of Sewer Adequacy
Inshuctions:
1,Complete Part 1 of application. Permit number may be added at later date.
2.Take application,Site plan,and any other assodatad Information with the proposed development to the Sewer
System Manager or Designated Employee for approval. public Health for review.
Submit mmpleted application and information to Permit Center or Mason County
NOTE:you must supply the System Manager with a site plan for the prole[,Showing 211 existing or proposed
sewer components and flues In relation to proposed development and property.
Part 1:Applicant/Parcel Information
Applicant: Lauren Fafnir,Agent for Lennar Northwest,Inc Dale: i l/7/2023
doing Address: 33455 6th Ave S,Unit 7-B city,Stale,Zip: Federal WE,WA 98003
Site Address:
290 NE Belfair Station Phone: (2S113"-mss
Parcel Number. t2326-51-MM Permit Number. RI
Part 2: Sewer System Information
'. Name Of$awar System: &1&ir
[v� Sit.Plan aaadred4
01Rcla)use only. Sewer System Manager orpesignated Employee rs to complete.
N cvmsaseIMro(INkvredlNaWllunla hfwnelpneM Mrerolvaw.xiNMYM ewM'VWYC HavNle�IwiMlae mr,e+PnrrLW
iMa.coafv PNma.
I ❑ Ewe'�o�hC O✓EMvanlCauMY Pr,rvL me eV4&enb lMomwBenaM lore rm Wue.wWl Meson Ca+ntl PmYCNsM ePP^rlr9 me
�. El `
IKuemM'eE Bx 1,Aa O".5an.M—Wbnuhuw.eeer mnns is o,nerNy NOT srNledeb tlb PoyM,
new aeG aw wlw q mroasMq on me rn,euoudne Mesas a Vennll tooau^e0
Must meet all Mason County design and construction standards,must Pay all fees
including:connection fee with permit and inspection f and Latecomers charge
Richard Dickinson 1119/23
i mmwx.m.dspea�Mxmxr E.vNre. sbwxedsrN.m x..ywnvq.e �°e,1/
PaQ 3:Mason County Public Health Review[Approval
Satafactory ❑ Unsatisfactory se slue drm'.axxnl om svecata
This form may be scanned and available for public view on the Mason County Web Site.
re.®vzv��