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Home My WebLink AboutBLD Sewer Adequacy - 8/24/2023 ENVIRONMENTAL 400546 HEALTH e15 N.aTH amaf ,BLpa 8,SHELTON Moral MASON COUNTY SHELTON:]lWlTdna,FM. W COMMUNITY SERVICES BELFNR:354-275U07,Me00 ELwk]ePK252aY,EM.alp SWJna.lYwiA4FnrYomnNNnah(mmnllYXeNM W 31X Ud-T S Application for Determination of Sewer Adequacy Instructions: 1.Complete Part 1 of application. Pmmit number may be added Of later date. 2.Take application,Site plan,and any other associated Information wM the Proposed development M the Sewer System Manager or Designated Employee for approval. 3.Submit competed application and Information to Permit Center or Mason County Public Heats for review. NOTE:You must supply the System Manager with a site plan for the prolect showing all ealst ng or proposed sewer components and lino In relation W proposed devalopment and property. Part 1:Applicant Parcel Information Applicant Sam Martin,Agent for Lennu Northwest,Inc Dam: 8/24/2023 Mauiig Address: 33455 lith Ave S,Unit I-B city,State,zip: Federal Way,WA,98003 SteAddress: 121 NE Ohmpk Use Phone: (253)194-1312 PINSINumber IB) 51-1100% HSKO Permll Number. Part 2:Sewer System Information Name of Sewer System: Beaty [vY Site Plan attached? Official use oW. Sawar Syefem Moral or Designated Employee is lo complete. EyN 1Wmdlor,, I haw rwkwad lM sue nh NwNe4an uk have no heuu H Mown Gs.*Pugk HWN spisft,Ne cMepnWlp ❑ EAW1 Cpmgbn: l ass m —d Ne srobnb lnlamrWn utl Mn m law wM M—nc ry IMBC Hush ayPoiie lM ,o,na dhp Mae CeuMy Pe=K ❑ IMw mlewM the egelcanla hl `ka sN Nos"aa mmd away pyre Jkn is amnw NOT ewibpM b 1N W sr,.. W Pas®Wew aeaeey..(a)on w a a asp nswan canal awmt fg ) Must meet all Masan County desgn and construction standards must pay all fee including:connection tee with permit and inspection fee gL4 Latecomers charge D . Richard Dickinson 9n123 P,wa XaM03mnn McWed FmWYae Slaw-NBYawn awas"EM^we OM Part : Mason County Public Health Review/Approval ZSatiafadpy ❑ unsatisfactory Senelure olfmlraersw hesN apedellM Ds �-( d?CTiyl o This form may be scanned and available for public view on the Mason County web She. awsmpemn