HomeMy WebLinkAboutBLD Sewer Adequacy - 4/25/2023 400449
415 N.WITH STREET,a DG 6,SHELTON NNBes6a
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Application for Determination of Sewer Adequacy Instructions: L0 I1
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1.Complete Part 1 of application. Permit number may be added at later date.
2.Take application,Site plan,add any other associated information with gle 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 91W plan for the project,showing all existing or proposed
sewer components and lines In relation W proposed development and property.
Part 1:Applicant/Parcel Information
Applicant Sam Martin,Agent for Lennar Northwest,Inc Date: 425/2023
Mailing Address: 3345561h Aw S,llnill-B,Ftdml Wxy,09W3 City.State,zip: Federal Way,WA,98003
Site Address I W NE Belrair Staurn phone: (253)2H-1322 �3 �l�/,
Parcel Number: 123M 51,"10 Permit Number-61(J pe A;2 - Q)
Part 2: Sewer System Information
Name of Sewer System' Belrair Site Plan ahachetl9
Ofliclaluseonly: Sewer System Manager er 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 inspecti�fee,and Latecomers charge(TEE).
Richard Dickinson 5/4/23
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Paayyrt 3:Mason County Public Health Review/Approval
ILf Satisfactory ❑ Unsafactoy
11 �Iureal Env9HeeIUS 1 pats
This form may be scanned and available for public view on the Mason County Web Site.