HomeMy WebLinkAboutBLD Sewer Adequacy - 4/25/2023 400452
415 H,erH STREET,,Bli e,SHELTON M vai
MASON COUNTY SHELTON:sar-W-9aio,1400
COMMUNITY SERVICES 400
E1M"am 4112-s2269,Pxr.4009a
lEwtheni PAX aeo427-n9e
Application for Determination of Sewer Adequacy L
lnateu.turni 1 1
1.Complete Pad 1 of application. Permit number may be added at later date.
2 Take applic ei Site plan,and any other associated information with the proposed development to the Sewer
System Manager or Designated Employee fa 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 W proposed development and property.
Part 1:Applicant Parcel Information
Applicant. Sam Martin,Agent for Lennor Northwest,Inc Data: 4/25/2023
Mailing Address: 3345561h Ave S.nnit l-6,federul wry,98003 City,State,Zip: Federal Way,WA,98003
Site Address: 160 NEBdfairSawn Phone (253)2%-113322,t 2 /� /� �i
Parcel Number: "out-SI-Scott Pemrlt Numr be T/IC 1 �Z"/- V N o.),
Part 2:Sewer System Information
Name of Sewer System: mfmr i✓7 Site Plan attacfred4
Official use only: Sewer System Manager or Designated Employee is to complete.
G NTe Ganne on: l mwe reWewed the apparatus nbmnlon and ham m ueuee wW,Masun Canty Pudk Hem,arching lManepaMna
Me.County PMnll
❑ Exialiw Cone bn: I have removed arc eppk rN intermarket and have he Hwu son Meson Cavity Public Heart approWna he
reeoveme Munn County Perrot.
❑ I hew rwbxed am vere—to hismar on ant min ha a dolt ed newt.—hei a m enlly NOT aueisark to the va vry l
Lyy Phew.Ne.1 is careworn)an Ne rmespa,dina Macon County.—I c ovararl
Must meet all Mason County design and construction standards must pay all fees
including:connection fee with permit and inspection fee,and Latecomers charge(TED).
Richard Dickinson y�-- '� _7"—' 5/4/23
IMaW Nsiwasnbm rbuatl EmWM Elpdr^ea 6nYm aMepN EiWp'ae oa.
Part 3: Mason County Public Health Review/Approval
Satisfactory ❑ I-mamisfai �C-" ' ""`' T° ' I�1 o-
SlanaWhe0Efmlrmne i*6 woo Dole
This form may be scanned and available for public view on the v/Maia„s`ooa}n County Web Site,