HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400479
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Public Health
Always waking fora safer healthler Mason County
415 N,eh Streek.Bldg 8,Shelton WA98584
360427-9670 or W-275 4467,extension 400
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pad i of applicalion. 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 protect,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 Northest Dale: 5115123
Mailing Address: 3345561h Ave S,Unit 1-13 City,Slate,Zip: Federal Way,WA 98003
Site Address: 261 NE Belfair Station Phone: 253-294-1322
Parcel Number: 1232851-00038 Permit Number. —60 2622+ W&00
Part 2: Sewer System Information l..6+ -26
Name of Sewer System. Belfair Sewer District 0 Site Plan attached?
OlNcieleseonly: Sewer System Manager or Designated Employee is to complete.
10 New eoareefix: I have i"ve e W appseris lnlamelen and have no Issues won Masan Cuorry P Ific Heats apprwinp lne wneepending
Me on crony PeMt.
❑ Exlatitpeonnoeko: Ihwomv wee Meapgitants NlarMIl aMhevanoiv 83xith Mewne WPuolic He ilhappwingaie
wrteapoMhp Moon Counry Permit.
❑ I nave reviewed the apoionts imomntion and have determined serer eonnudion is wmMfy NOT ewouix,w this prowmy
® PMm auk!she lelko g curMluw(s)on the wnewwdiig Mason CwMy Petit nericrall
Must meet all Mason County design and construction standards, must pay all fees
including: connection fee with permit and inspection fee,and Latecomers charge(TBD).
Richard Dickinson
..........—cen cnsb/ee sYTave aaA�mn Me S.ee^GIeR.
Part 3: Mason County Public Health Review/Approval
Satisfactory ❑ Unsatisfactory •+� C�,SP�,
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This form may be scanned and available for public vlew on the Mason County Web SIN.
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