HomeMy WebLinkAboutBLD Sewer Adequacy - 8/11/2023 400537
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MASON COUNTY
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Application for Determination of Sewer Adequacy
InsWdions:
1.Complete Part 1 of applka rn. Pemlit number may he added at later dale.
2.Take application,SAO plan,and any other associated irdomlation With the Proposed development to the Sewer
System Manager or Desgnated 6nP10yee 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 slte plan for the project,showing all existing or proposed
sain r components and Ilrwa In relation to proposed development and property.
Part 1:Applicant I Parcel Information
Applicant Sam Martin,Agent for Len=Northwest,Inc Date: 8/11/2023
Mailing Add
33455 6th Ave$Unit 1-B City,stela,ap: Federal Way,WA,98003
kSite Addre55: 211N 01ymPkaidg Phone: (M)2Wl322
Pal number. l+ae."51.aDos1 Ns.el Permit Number. Ri n .oaf-oaa73
Parcel
Part 2:Sewer System Information
Name of Sewer System: adfti+ i� Site Plan attachad?
OFfdal use only. Sewer System Marmger orow9nawEmpbyee fs w cumpleta
New Cm ff hero IChxM IM1e e{gicaXs Ir,ltmaliul a^E M1averoiaweawitl,MaaM tolnlyPWMc HeaXh appwirq tM1e wrteya✓Jlnp
Masco Count'FWrna
❑ Evatllq Lonllbn IlwareriexeG tlw appka,tle lnlNmatlan ant aerommuc aiN MavanGwnry PuGONdYn approviry be
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❑ I M.mWWNu tlw aWk°r'1a iManvtim ant Nw&rW,,W eeeve owr limb axr j NOT available b Uie p l"v
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Must meet all Mason County design and construction standards, must pay all fees
incin. nnection fee with '
Imit and ins on fee, and Latecomers char a
Richard Dickinson 8/15/23aarnge.. slaw.aeraaeNmeeM F.amwee oXe
Part 33: Mason County Public Health Review)Approval t y IZz�L�
rT Satisfacrory ❑ Unsatisfactory sip,.elnd Heeims t_ A n PON� d/CChd��rrn O.eXd61e() _
This forth may be scanned and avaaable for public view on the Mason County Web Site.
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