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Home My WebLink AboutBLD Sewer Adequacy - 3/6/2024 �AsoN COUnArN rA Public Health Always working for a safer healthier Mason County 415 N.6th Street,Bldg 8,Shahan WA 985M 360427-9670 or 31 extension 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 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 Heath 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 KLUSMAN,Strider& Pam Date: 3E-2024 Mailing Address: 145 E BARNACLE BLVD City,State,Zip: SHELTON WA 98584 Site Address: 155 E NANTUCKET RD Phone: (360)490-5272 Parcel Number. 12119-54-00005 Permit Number. Part 2: Sewer System Information Name of Sewer System: HARTSTENE POINTE WATER-SEWER DISTRICT ❑ Site Plan attached? Official use only: Sewer System Manager or Designated Employee is to complete. ® New Connection: I hove madded Me appllcantsirubmaton and have no Iwues with Mown County Public Hall appacOng to wnesporaing Mason County Pel.it. ❑ Existing,Combat..: I have miewed Me applicants I.forde ion and have no tasues ash Mawr County Pudic Hall approving Me corresponding Moon County Parts ❑ 1 have missend Me applicant Infarmahob and have dtentned sewer connection is wrnary NOT available M Mis pmpany ❑ Please add Me following antlitlorod on Me mr,eapalding Mown Oouny Penlit(opOmed Jeff Palmer, General Manager / - - 3-6-2024 "n'.n Nam.of a...m....wEnipsvdd sgMtura[I Sinai waasser,onsavee,, , Gala Part 3: Mason County Public Health Review]Approval Satisfactory ❑ Unsatisfactory Sgando.ofEinnodureannifoartsibeciond Dale This form may be scanned and available for public view on the Mason County Web Site.