HomeMy WebLinkAboutBLD Sewer Adequacy - 7/25/2023 400533
05 N.STH STREET,BLOG S.SHELTON wA 9e591
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MASON COUNTY
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COMMUNITY SERVICES ELMk M"52-5269,EXT.IN
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FAX:36"27-779e
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 to proposed development and property.
Part 1:Applicant I Parcel Information
Applicant Sam Martin Agent for Lennar Northwest,Inc Date: 7/25/2023
Mailing address: 33455 6th Ave S,Unit 1-11 City,state,Zip: Federal Way WA,98003 _
Site Atldress: 251 NEOlym 'c Rid e
Phone: (253)2%-1522
i
Parcel Number ..."s S1-0oon Permit Number:
1 Part 2:Sewer System Information
iklfvr Site Plan attached?
Name of Sewer System:
Official use only: Sewer System Manager or Designated Employee Is to complete.
Ed New Comeeten: I have reviewed me appMenle mioneelion ark have m I..-wM Neeon county Public Hoare,appmaq me 000eWendln9
Maeon ceunly PMmil
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❑ Eke6r19 Genr,eone, 1 Mve reviewed me applicants inwmetion ark have ezuea wiM Mown County PNNic Hea1N eppravine ea
nspo,kirg Maeon County Poet-
,M1eve reviewed the appflce d.inknnomen end Iuve detelrnn.d.ewer..W1 n 1.-nondy NOT avalblwe b me Plp
ad pleeee add me mllvwog mrkilbMe7 on me wmspommn9 Mason cm nn,PemJL i'tkne1) 1
Must meet all Mason Count design a d ion n rd
I including: connection fee with ermit and ins ction fee and Latecomers char a SD .
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7 Part 3:Mason County Public Health Review/Approval
1 Satislacto ❑ Unsatisfactory
Lyl' ry SlpreN.2l of EnvMonmen NWMBpeJdaset I� pab
This form may be scanned and evadable for public view on the Mason County web Site. sere..1
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