HomeMy WebLinkAboutBLD Sewer Adequacy - 8/11/2023 400538
415 N.eTH STPEET,BLDG 9,SHELTON VAWW
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of application. Permit number may be added at laterdate.
2.Take application,Site plan,and any oilier associated Information VAM 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 Me System Manager wgh a alto plan for the protect,showing all eaisting or proposed
sewer componMte and lines In relaWn to proposed development and property.
I
Part 1:Applicant 1 Parcel Information
Applicant Sam Martin,Agent for Lennar Northwest,Inc Date- 8/11/2023
Maims Address: 33455 6th Ave S,Unit 1-8 city,State,zip'. Federal Way,WA,98003
Site Address: 24l NEOlympk RNga Phone: (253)N4-1133222�
Parcel Number. In28-51-00oe2 H5 a82 Permit Number:
Part 2:Sewer System Information
Name of Sewer System mfair v[) Site Plan attached?
F
l use only- SewerSystemManagerorDesignatedEmployeeistocompkte.
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Must meet all Mason County design and construction standards must pay all fees
inclu - : connection fee with permit and inspection fee, and Latecomers charge ).
Richard Dickinson 8/15/23
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Pa Mason County Public Health Review)Approval
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This form may be scanned and avartable for public viaw on Me Mason County Web Site.