HomeMy WebLinkAboutBLD Sewer Adequacy - 8/24/2023 400547
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Application for Determination of Sewer Adequacy
Instructions:
I.Complete Pad i of application. Permit number may he added at later date.
2.Take applicator,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 site plan for the project,showing all exist ng or proposed
sewer components and lines In relation to proposed development and property.
Part 1:Applicant/Parcel Information
Applicant Sam Martin,Agent for Unnar Northwest,Inc Date. 8/24/2023
Melling Address: 33455 6th Ave S.Unit 1-B City,Stare,Zip. Federal Way,WA,98003
Site Address: III NE OIympk Ri* Phone: 053)294-1312
Parcel Number. I)328-51-ae0a1 N5a91 Permit Number. Lb;?49�QD/�
Part 2:Sewer System Information
Name of Sewer System: &Hair (vY Site Plan attached?
Oglctaf us r only: Sawar System Manager or Designated Employees 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,and Latecomers charge(Tout.
Richard Dickinson 9///23
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P@rt 3:Mason County Public Health Review/Approval
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This form may be scanned and available for public view on the Mason County Web Site.