HomeMy WebLinkAboutWAT Application - 7/24/2023 400513
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MASON COUNTY SHELTON 35b43r-981o,W.480
COMMUNITY SERVICES BEI-FAlt
EUMN 8062 8 ,ET.480
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of application. Permit number may be added at later tlale.
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 b 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 Lem"Northwest,Inc Data: 7/24/2023
Mailing Address: 33455 Sth Ave S,Unit I-B city,state,zip: Federal Way,WA,98003
Site Address: 280141101ympic Ridge Phone: (253)2%1322
Parcel Number. 12328-5I-0oos Permit Number. aLtgaL+Cohn
Part 2: Sewer System Information
Name of Sewer System: Belfeir Site Plan atlerhedy
Official use only: Sewer System Managers 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 inspt'oon fee and Latecomers charge(TBD)
Richard Dickinson 8/4/23
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Part 3: Mason County Public Health Review/Appm
R�Sallsfactory ❑ Unsatisfactory
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This form may be scanned and available for public view on the Mason County Web Site.
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