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HomeMy WebLinkAboutBLD Sewer Adequacy - 3/9/2020 (2) ENVIRONMENTAL HEALTH Public 77 gpi Health IIt nl1 muty Il llli Its G, . Always working for a safer R healthier Mason County 415 N.81h Street,Bldg 8,Shelton WA 98584 3e0427-9670 or 360-2]5446],enension 400 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 with the proposed development to me Sewer System Manager or Designated Employee for approval. 3.Submit completed application and information to Perm It 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 Imes In relation to proposed development and property. Part 1:Applicant/Parcel Information Applicant: J &J Development LLC Dam 3/9/2020 MulingAddress: PO BOX 623 city,state,zip: Burley WA 98322 Site Address: Block 52,Lot 8 Phone: 253-208-8136 ., Parcel Number: 12220-50-5200& Permit Number�Id n e) -b6f-�'1�I —Tins erccl Is currency being amides.Pl..'mce"cam manna Part 2: Sewer System Information _ Name of Sewer System: ❑ Site Plan attached? - OMclal uae only: Sewer System Manager or Designated Employee is to complete_ New Cd mactim: I newe reviewed the applicants naalma4on and have no Issueawith Masan County Public Health approving be corresponding Meson county Perm". ❑ Fnehg Can UW: IIIaVe levlBWed Ne apphf2ntE ln(Ormahon and here oo'IseueS Wiln Mason County PudiC HealNapproving the ymleappndinp Mason Cover,Pennh. ❑ I/cove reviewed re applicants inbrrtation and have determined sever connection is currently NOT tneilat e W this pmpeM- fleau add the lolleeing Inedrain(sl on the wriesporeing Meson townN Permit.(deremr) t I 1 . PinWNareavesem NseeinEciares adeae'ed8ye1em Manapen Els". Pale Part 3: Mason County Public Health Review/Approval ❑ Satisfactory ❑ Unsatisfactory 9�� Signature of Environmental Hearth Specialist data This form may be sunned and available for public vlew on the Mason County Web Site. s� , � ©� (trot 4-,D �� e�