HomeMy WebLinkAboutBLD Sewer Adequacy - 7/24/2023 400531
415 N.6TH STREET,a1DG 6,SHELTON WA sx561
MASON COUNTY SHELTON: 6o-4n-9B 0,EXT.400
MA:COMMUNITY SERVICES a OElwI 3aM1nS-1161.E 400
E1 2 6 618 3-5160.IXT.T.400
9WAiry Nit Nit EmYmmnbl HuW Qxm—'ry NUM FAX 38e1Tr-P06 [
Application for Determination of Sewer Adequacy
'.. Instructions:
1.Complete Pan 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 Intonation 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 W proposed development and property.
Part 1:Applicant I Parcel Information
Applicant Sam Martin,Agent for Lennar Northwest,Inc Data: 7/24/2023
Mating Address: 33,455 6th Ave S,Unit I-B city,stain,zip: Federal Way,WA,48003
Site Address: Yll NE 0lvm ' aid Phone: (253)SW-1322
Parcel Number. mu-51-0 5 Permit Number.
Part 2:Sewer System Information
Name of Sewer System: adhir Ig She Plan attached?
oficWuseonly. Sewer System)Wwageror Oeslgrrated EmployeeisWmmplete.
Ba Nur Cvnpe lMC IMa m'IvweE Ote aPPlicver lnrcrt1u1k11aM lnwNlasuss wAh Maven Caunry PUOlk HaellN appmmn9tM mnepwnE'm0
Main U�Pamvl.
❑ FrhlNq CaveGon INevereviewed Ne epp&nis NrwmeOon and lave no lsauea wlN Mason Oouny Pudk Heats apprwMg Ne
caurymUNO Masan Goun[y Permit.
❑ IMve leveveE as appBmts inlanarxn aM lave deteminsd sew mnrodNn k mm«,w NOT evep NWa WoRedY
Plsm add l e lek ft mMl srn5)col as onnespsm ng Nam.coon,P.(epaana4
Must meet all Mason County design and construction standards must pay all fees
' mdua lin :connection fee with permit and ins ion fee tecomers cha a BD).
i
Richard Dickinson 8/423
j. P,NW Naeeswumw.vwraaio,.. siaaun aeY+.nM.aeal eeyer.a ar
Part
ppp3:Mason County Public Health Reviewl Approval r'Jq^^ v"1 Ldiu
I�Satisfactory ❑ Unsatisfactory I V' ^�/y • • • l
I/ Skrass.w Envirc a Nwm SpeeslNt ^
N CFI�f� �II�
This form may be scanned and avallable for public view on the Mason County Web She.
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