HomeMy WebLinkAboutBLD Sewer Adequacy - 7/25/2023 400510
415 N.eTH STREET.BLDed G.WELTON VIARusal
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of application. Permit number may be added at later date.
2.Take application,Site plan,and any other associated information witjf 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 I Parcel Information
Applicant: Sam Martin,Agent for Lennar Northwest,Inc Dam: 7/25/2023
Mailing Address: 33455 6th Ave S,Unit I-B City,State,zip: Federal Way,WA,91W3
Sile Address ]Sp Na Olympic Ridge Phone: (253)29f-1333
Parcel Number. Permit Number. zo cz
Part 2:Sewer System Information
Name of Sewer System: Wfm d Site Plan attached?
OXle/el use only: Sewer System ManagerorDesigratedEmployee 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 inspection fee,a omers charge(TBD).
Richard Dickinson 8/4/23
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Part 3:Mason County Public Health Review)Approval a/1(�I � Zh I2' 1
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This form may be scanned and available for public view on the Mason County Web Sim.
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