HomeMy WebLinkAboutBLD Sewer Adequacy - 8/23/2023 415 N.eTH STREET,BLDG B,BHELTON NM 985M
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pad 1 of application. Permit number may be added at later dale.
2.Take applicator,Site plan,and any other associated Information with the proposed development to the Sawa,
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 is Applicant Parcel Information
Applicant: Sam Martin,Agent for lxnnar Northwest,Inc Date: 8/23/2023
Mailing Address: 33455 6th Ave S,Unit I-B city.State,Zip: Federal Way,WA,98003
Sfte Address: 131NEOlympkWE phone: (253)2%-1332
Parcel Number, l232t-51-000e9 aa+e9 Permit Number. � JIXQR4—l.U,5 L
Part 2: Sewer System Information
Nameof Sewer System: ExIfalr 6/site Plan attached?
Official use only: Sower System Manager ar Designated Employee Is to complete.
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dawn county Permit
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Y Must meet all Mason County design and consW ction 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 Reviewl Approval
Satisfactory ❑ unsatisfactory
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This form may be scanned and available for public view on the Mason County Web Site.
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