HomeMy WebLinkAboutBLD Sewer Adequacy - 2/14/2024 P+SON COUry +0C1
PublicHealth
Always working for a safer , healtMer Mason County LGG
415 N.6th Street,Bldg 8,Shelton WA985M '`Os
360427-9670 or 360-2754467,extension 400 co
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pan 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: Sean & Libby Finerty Date: 2/13/24
Mailing Address: 204-B 183rd St SW city, State,zip: Bothell, WA. 98012
Si aAddress: 440 E Lakeshore Dr. Phona: 206-931-3967
Parcel Number'. 12220-54-00042 Permit Number: apply on 2/21/24
Part 2: Sewer System Information -50 202A —QD as
Name of Sewer System: \I �5( 1 Y Site Plan atleoll
Official use only: SMMerSystem Manager or Designated Employee is to complete
® Nov Coorkwon I hero renewed to epplicante infarmahw and have no issues with Mason County Pudic Heeah approving the mnespoMing
Maw County Pmnit
❑ Ealong control Ih.revkwed the appNcants information and have no issues with Now Count,Pool Health apprdvIN the
wrreawnding Moon County Pe,mh.
❑ I he.(NI.W tb appllunle lnramalknend have tMermlren sewer wnnectlon is conentty NOT awilade b Mls propeM.
❑ Pon.add Mefclbwing daWiepn(p on the wnawridina Mawr County event o okoal)
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This form may be scanned and available for public view on the Mason County Web Site.
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