HomeMy WebLinkAboutBLD Sewer Adequacy - 7/25/2023 400532
415 N.5TH STREU,Buoo a,SHEITON N259B504
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Application for Determination of Sewer Adequacy -
InsWcUons:
1.Complete Part 1 of application. Permit number may be,added at later date.
2.Take application,She 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 Persil 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 Dam: 7/25/2023
Melling Address 33455 6th Ave S,Unit 1-B City.State,Zip: Federal Way,WA,98W3
Site Address: 261Nea Rid Phone: (253)2g4-1522
Parcel Number: 12328-5100026 PemhR Number. J/A� "lvtJ7✓�
Part 2: Sewer System Information
Name of Sewer System: arirair LJ Site Plan attached?
onklat use only: Sewer System Manager or Designated Employee is to complete.
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Must meet all Mason County design and construction standards, must pay all fees
including-connection fee with permit and inspection fee and Latecomers charge(TED).
Richard Dickinson 81423
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Pal 3: Mason County Public Health Review/Appr a Q CC
I Satisfactory ❑ Unsatisfactory
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This form may be scanned and available'!public vim o the aeon C unty wab Sim.