HomeMy WebLinkAboutBLD Sewer Adequacy - 11/7/2023 400487
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pad 1 of application. Permit number may be added at later date.
2.Take application,Site plan,and any other associated information wth the proposed development la Ihe Sewer
System Manager or Designated Employee for approval.
3.Submit completed application and information to Permit Center or Meson County Public Health for review.
NOTE:you must supply the System Manager with a age plan for the project,showing all existing or proposed
sower components and lines in relation to proposed development and property.
Part 1:Applicant Parcel Information
Applicant Lauren Fafnis,Agent for L. ar Northwest,Inc Date: 11/7/2023
Mating Address: 33455 fith Ave S,Unit 1-8 City State,zip: Federal Way,WA,98003
Site Address:320 NE Belfair Station Phone: (2s3)9a6-02ss
Parcel Number. 1222b-51-eee29 Permit Number. l3Lh9!0 4—(22m--3
Part 2:Sewer System Information
Nameof Se System: Beheir Ef Site Plan atedver?
olfic(al use o y: Sewer System Manager orOesignated Employee Is m complete,
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Maur cunty Permit.
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Must meet all Mason County design and construction standards,must pay all fees
including:connection fee with pemlit and inspection fee,and Latecomers charge OW).
Richard Dickinson 111923
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Part�3:Mason County Public Health Review/Approval
y]�satisfactory ❑ Unsatisfactory
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This form may be scanned and available for public view on the MasonCClountyWeb\She.
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