HomeMy WebLinkAboutBLD Sewer Adequacy - 12/1/2023 la D ) 03 l�
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MASON COUNTY SHELTON:36642745M.EXT.400
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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 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 aka plan for the project,showing all existing or proposed
sewer components and lines in relation to proposed development and property.
Part 1:Applicant l Parcel Info adon aedq
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Site Address: /D9 fib?M�1 Phpre: !� I.O — 6
Parcel Numbers i„tD a D_.�B_ 9DD Permit Number: DIG242,4 ^ "j
Part 2:Sewer System Information �
Name of sewer System: - ;{1, y9B Site Plan attached?
oteehl use omy, Sswer System Manager or Dealgnsh f Employee Is to complete.
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Part 3:Mason County Public Health Revlevd Approval ?JJ
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This form may be scanned and available for public view on the Mason county grab Sib.
_ RECEIVED
JAN 012024
Mason County Utilities Cu "C k firr 1.,C
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