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HomeMy WebLinkAboutBLD Sewer Adequacy - 2/14/2024 �Ps"� ``ut"�r• RFC Public Health 41as,#00 Always working N N Street58Wg 8,Shelton WA M584alther Mason untY vnry CO, j- 360427-9670 or 360-2754467,extended 400 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 me 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: Ryan Holman Date: 2113124 Meiling Address: 4301 Forest Beach or City,State,Zip: Gig Harbor,WA.98335 Site Address: 451 E North Bay Rd Allyn WA 98524 phone: 253-302-7145 Parcel Number: 12217-44-00040 Permit Number: . BLDaD2sF'AO� Part 2: Sewer System Information Name of Sewer System: NBCI ® Site Plan attached? OIBcMI use only: Sewer System Manager or Designated Employee Is to compilers. New Cmmclion: I hero reviewed the apgkants'mfermetlon and have no Issues with Mown County PWgo Naha approveng se oonarpaNeng Meson County Parmlt. ❑ Exislarg ConrreGbn'. I hew reviewed the Mountanb inlormatan eM here no issues with Meson County Peluso Health appmNng the correspoMing Mown County Pairs. ❑ t hew reviewed the appli®n4 intwmatbn and have determined sewer connection is currently NOT available to the trader, ❑ Posses was the son wo,mrMltlmte on IM evneeponsing Mown County Pemit.(swords / ul� 2 C ecs r �a ssuaK e j;..eldei � ,k . MYe.1Nsre NaYdem M1<ngpN Er,pbtw cases.M ayaMn AMgw Eno, Ab Part 3: Mason County Public Health Review/Approval 2,f JJ)41 $aDsfactory El Unsatisfactory 1V J 11YYJJ SignalureofEnsuricArdindialHeatsnSpneWll'f Dale -4 1 Cw&Th A4n aAc#�-�l This form may be scanned and available for public view on the Mason County Web Site. aeear'saidee