HomeMy WebLinkAboutBLD Sewer Adequacy - 5/15/2023 400466
�ooN Covill
Publidl Health
Always working for a safer healthier Mason County
415 N.61h Street.BNB 8.Shellon WA 985M
360>37-9670 or WO-275-4467,extension 400
Application for Determination of Sewer Adequacy
Instructions: I f a
1.Complete Part 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/Parcel Information
Applicant' Sam Mahn,Agent for Lennar Northest Date: 5/1523
Mailing Address: 33455 61h Ave S,Unit 1-6 City,State,Zip: Federal Way,WA 98003
Site Address: 111 NE Ridgetop Crossing Phone. 253-294-13322 '-1
Parcel Number 1232a-51-00022 Permit Number: p ild 26y�37—(JI� 1
Part 2: Sewer System Information
Name of Sewer System: Belfair Sewer District ® Site Plan attached?
Official use only: Sewer System Manager or Designated Employee is to complete.
® New Connection: Inew revcwetllM eplMiunOlnlamallm eM Mve no lesueaxXM1 Mssen Lwnry PWlic NeelN eppravn0111e wrrespanEirp
Mewn County Paml.
❑ Existing Connection: I hews reviewed the,epl roars informslbn and Mve no Issues wiN Mesm County PWlk Health appmWp the
wnespondn0 Mawr County PemYL
❑ I nave revleweE the apnnanb Information and have determined sewer wnmcllon is wrrontry NOT evallabM so this property
® Pleaw add notdlew'ng wassail)on file corresponding Mason County Pernal opspneq
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 6112n6
PnYa Hamed9ypem Manepetl EuNoyee ' Saran vanaped Empinree
Part 3: Mason County Public Health Review/Approval
Satisfactory ❑ Unsatisfactory �•�tyt.,� W
sgluare nYEivifn)ItartaI�H neq-ntspeoalial ,Dale,
This form may be scanned and available for public view on the Mason County Web Site