HomeMy WebLinkAboutBLD Sewer Adequacy - 8/23/2023 -ioo 51-W
415 N.eTH STREET,atece,SHELTON NA98501
MASON COUNTY SHELFAR:39Y41-a510,EXT.400
COMMUNITY SERVICES 9EEWA,aa09 -620a,IXT.<0a
EIMR:JCa4aa-5280,IXL 1W
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pan 1 of applicaaon. Permit number may be added at later date.
2.Take application,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 existing or proposed
sewer components and lines in relation to proposed development and property.
Part 1:Applicant Parcel Information
Applicant: Sam Martin Agent for Leaner Northwest,Inc Date: 8/23/2023
Meiling Address: 33455 6th Ave S,Unit 1-B city,State,zip: Federal Way WA 98003
III NE DIymyk Ridge Proper (253)M-1322 ��11 aa��tn7�t,
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Parcel Number. 1Dza-5l-emcee PerMl Number.
'., Part 2:Sewer System Information
Name of Sewer System: aeifair ® She Plan attaehetl4
Official use only: Sewer System Manager or Designated Employee Is la complete-
r e applkmis ln,xPx N and have ro Issuer,with Masan Cul Public Heath epp,avNp Me wMNPOMap
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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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Part 3: Mason County Public Health Review/Approval
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�I This form may be scanned and available for public view on the Mason County Web Site.
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