HomeMy WebLinkAboutBLD Sewer Adequacy - 2/28/2024 MASON COtJ V�
Public Health
Always working for a safer healthier Mason County
415 N.6th Street,Bldg 8,Shelton WA 98594
360-427-9670 or 360-275-4467,extension 400
Application for Determination of Sewer Adequacy
Instructions:
1. Complete Part 1 of application. 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: Christopher Osolin Date: 2128/2024
Mailing Address: 1008 Western Ave,Suite 215 City, State,Zip: Union,WA 98592
Site Address: 7261 East Route 106 Phone: 206.933.8228
Parcel Number: 3223350-00017 Permit Number BLD2024-00111
Part 2: Sewer System Information
Name of Sewer System: Alderbrook Waste Water ® Site Plan attached?
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only: Sewer System Manager or Designated Employee is to complete.
onnection: 1 have reviewed me applicants information and have no issues with Mason County Public Heelm approving Ma coraspondin
county Permit.
g Connection: I have reviewed the applicalrts information and have no Issues with Mason County Public HeaM approving the
ponding Mason County Permit.reviewed the applicants Information and have determined answer connection Is currently NOT sminlabie to this property.
add Me fallowing conditlon(s)on Me corresponding Meson County Permit rophor iwd Name 0 System imaged Employee SlgneWre of system Manegerl Employes one
Part
3: Mason County Public Health Review/Approvall
Satisfactory ❑ Unsatisfactory I I
Signature of EnNronmenfal Health specialist Data