HomeMy WebLinkAboutBLD Sewer Adequacy - 8/23/2023 900 >,q D
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MASON COUNTY SHELTON:360.4P4467.re.EXT.
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COMMUNITY SERVICES BE aF '.36a2)S446r,EXT.400
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pan 1 of application. Permit number may be added at later date.
2.Take applimthm,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 revlew.
NOTE:you must supply the System Manager with a site plan for the project,showing all existing or proposed
sewer components and lines In rstation to proposed development and property.
Part 1:Applicant l Parcel Information
Applicant Sam Martin Agent for Lennar Northwest,InC Date: 9/23/2023
Mailing Address: 33455 6th Ave S,Unit I-B city,seam,Zip: Federal Way WA 98003
Site Address: 1e1 NE Olympic Ridge Ph". (253)2%-1M tinnn
Parcel Number: 1ll3-5t-BIIaM its 84 Permit14 be �� till
Part 2: Sewer System Information
Name of Sewer Sysem: Belie" ® Site Plan Mached?
oMcialuseonly: Sewer System Manageror Designated Empioyea is to complete.
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❑ EebWq ConmcYwl: IM1aw reWeweB NeepolreMs lnlametioneM Mva rmluumaviN Mewn County Publle HealN epprwirq the
wneepw feq Mewn CwMy Permll.
❑ Ihew i¢vbveCNe eppiwnb lnrormeOm eM Mve tlebrn'inetl nswerwnnalicn rs a+rranlry NOT rvaIIeGleblMs propeM
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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(TBD)
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Pa 3 Mason County Public Health Rev[GvA Approval Ca n ,_, �„M
alisfactory ❑ Unsedsfacmry Ir 11I�•VYUCD irI MIn MMff��
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This form may be scanned and available for public view on the Meson County Web Site.
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