HomeMy WebLinkAboutBLD Sewer Adequacy - 1/2/2024 Envelope ID:0867ED71C87FiEC3-85A1-78FF51524F34 Ck 15 Li
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Public Health
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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pan 1 of application. Permit number may be added at later date.
2.Take application,She 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 most 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 3H Rigger Enterprises - Scott studerus Date: 1/2/2024
Mailing Address: PO sox 985 City.State 7}p: selfair, WA 98528
Site Address: 23240 E State Route 3 Belfair 98528 Phone: 360-850-8500
Parcel Number 12332-50-00021 Perim Number.BM&24—0070,6
Part 2: Sewer System Information
Name of Sewer System: Belfair Sewer System L] Site Plan attached?
Of vital use only: SewerSyafem Manger or DeslgnaW Employee is tb complete.
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Part3: Mason County Public Health Review/Approval ^ /M/�y
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This form may be scanned and available for public view on the Mason County Web Site.