HomeMy WebLinkAboutBLD Sewer Adequacy - 8/11/2023 400539
415 N.M STREET,W-DO q SHELTON Mass"
MASON COUNTY aHELTON:se -Ve+1?e'�`""
COMMCJNIT ( SERVICES 6E N0.: 90-95Ma.E%T.1pe
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Application for Determination of Sewer Adequacy
Instructions;
1.Complete Pad 1 o(applimtion. Permit number may be added at later date.
2.Take application,Site plan,and any other associated information with the proposed development Ie the Sewer
System Manager or Designated Employee for approval.
3.Submit completed application and informaWn 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 I Parcel Information
Applicant Sam Martin,Agent for lennar Northwest,Inc Dale: 8/11/2023
MauingAddlese: 33455 6th Ave S,Unit 1-B Co.State,zip: Federal Way WA,98003
Sde Add.: 9 NE OHm kA'd phone: (2531291-U22 n t ,�,I�a��
Parcel Numbe, 123a51'00043 HS In Pelmg Number.
Part 2:Sewer System Information
Name of Sewer System'. aegak 13 Site Plan attached?
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only: Sewer System Manageror Designated Employee fs w compkfa
nneCMC lM1are revkNeClM aaurMPaTR Can,ver: I . r Per,vr lM ppliq Ap¢ui LwMr PerMtuiovieE ra apPFsn lnlm smsoal vlatl ¢meGon c a vAy NOT warvuc b lma r,,NnyabV bWwlna wvJ".)m M vnea ays,hewn cwM'Pwml lry )
meet all Mason County design and construction standards,must pay all fees
di nectbn fee wim rmit and Ins lion fee and Latecomers ch D .Richard Dictdraon e/15/23
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Par{.9: Mason County Public Health Review/Approval
Ssatisfactory ❑ Unsatisfactory
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rids form may be scanned and avaaaWe for public view on the Mason County Web Site.
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