HomeMy WebLinkAboutBLD Sewer Adequacy - 7/30/2024 415 N.STH STREET,BLDG 8,SHELTON WA 9084
MASON COUNTY SHELTON:360427-070,F T4W
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Application for Determination of Sewer Adequacy
Instructions:
t.Complete Pan t of So fication. 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 W proposed development and property.
Part is Applicant I Parcel Information
Applicant: ;\ tM 4 M;LLe& H ae ah lcl Date: -y/;b'zewy
Mailing Address: Q.O &yx Ln 1t City,State,Zip: Ally. rd WN `fab.�(
Site Address: �{7i^b��l1n/�9�a /�i.+ It :.�1�o"N� s4 Phone. 212; ��'YAf�-21 1[ - -2'-1 j(7i
Parcel Number: Ivfa O1.N) -%D— �� Permit Number: DO'"rLl r
Part 2: Sewer System Information
y
Name of Sewer System' t IO a ❑ Site Plan attached?
Official use only: Sewer System Manager or Dealg"W Employee Is to complete.
Nav Ccmecfion: I hero mieeed the applicants lnomrodon and haw no aawawlm Mason CmnM Pudic HeelM approving to mneapa'Aing
Mo.rivw,ly PemiL
�ENadng Onnnecem: I low ravwwed tlre,ay pNunainnxrawm endh no lasuea1wlnMmnCmnT Public Haeltll appmvly
mrr.,oninp Memn LouMypema. LohU PJSID/1 1DM LCI+ok. M. lip{
❑ Ihaw hw wedtie apokxMa hoomatim cant hwadelemined sewermnmcdmhamMN NOT available bPispmpeny J
❑ Please add the idbwin i m,wnonlel on the mneaddrom,Mason CeunN Pmma fthkv eg
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Part 3: Mason County Public Health Review/Approval ,/i .� „ _ _ �yjn q I
Satisfactory ❑ Unsatisfactory ��7�nhr� e •o l _ l 1aJ
1\" SpneNre of Envirmmen eallh Spetlalin Data
This form may be scanned and available for public view on the Mason County Web She.
MASON COUNTY Service Address District
UTILITIES/WASTE MANAGEMENT 430 E SULLIVAN ST North Pay
100 W Public Works DR Account Number Due Date Amount Due
Shelton WA 98584 500336 07/31/2024 $175.92
AMOUNT ENCLOSED
HAECHLER, MICHELLE & JAMES Please make check payable to
PO BOX 1015 MASON COUNTY TREASURER
ALLYN, WA 98524 UTILITIES/WASTE MANAGEMENT
100 W Public Works DR
Shelton WA 98584
Please return top portion with your payment
ease retain, is po ion or w�.reco; s •.e�
Service Address Account Number Bill Date Due Data Amount Due
430 E SULLIVAN ST 500336 07/01/2024 07/31/2024 $175.92
Date Meter Read Meter Readings
Meter Number Current Consumption
07101IM24 o7 0
Beginning Balance _$64 .08
NBCI Duplex connected JUL Sewer Charges 240.00
Balance Due $175.92
AUTO-PAY - DO NOT REMIT PAYMENT
Pay your bill online:
www.masoncountywa.gov
Quick Links- Pay My Utility Bill
Customer Service Hours: 8:00 AM to 4:30 PM Monday-Fdday
Billing or Service Inquiry-Normal Business Hours: (360)427-9670 E#.207
Emergencies-After-Hours Only: (360)490-1822