HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400467
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PublicHealth
Always working for a safer healtler Mason County
415 N.81h Simi,Bldg 8,Shellon WA98584
360427-9670 or WO-275-4467,eilension 400
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pan 1 of application. Permit number may be added at later dale.
2.Take application,Site plan,and any other associated infooneflon 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 Manin,Agent for Lennar Northest Date: 5/15123
Mating Address: 33455 fit Ave S,Unit 1-B City,Slate,Zip: Federal Way,WA 98003
Site Address: 101 NE Ridgetop Crossing Phone: 253-2844322 t
Parcel Number 12328-51-00023 Permit Number: Pnl12.6z�3 . OI-17
Part 2: Sewer System Information
Name of Sewer System: Belfair Sewer District 0 Site Plan stached?
Official 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(TBD).
Richard Dickinson 611223
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Part 3: Mason County Public Health Review/Approval
Satisfactory, ❑ Unsatisfactory
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This torn may be scanned and available for public view on the Mason County Web Site.
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