HomeMy WebLinkAboutBLD CD Environmental Health Review - 11/7/2023 400517
415 N.M sTRE ,,eLp36,SHELTON M 0159e
MASON COUNTY 6r1E1TON:aea4P Wa,E ..4eo
COMMUNITY SERVICES BEEIAV, aZS4"''EXT'440
EIAN:a60.1u3a6a,E%T 4.
Ovkh si'l 96,NavwYl Hmtlh CwnmNly XeePE FAC aOaiZr-]]BE
Application for Determination of Sewer Adequacy
InsWctions:
1.Complete Pan t of application. Permit number may be added at later date.
2.Take application, Site plan,and any other associated Information with the Proposed davebpmeM to the Sewer
System Manager or Designated Employee for approval.
3.Submit completed application and mlormafion 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 tines in relatian to proposed development and property.
Part 1:Applicant/Parcel information
Applicant Lauren Fafnis,Agent for Lennar Northwest,Inc Date: 11/7/2023
Mailing Add.: 33455 6th Ave S,Unit I-B city,.state,zip: Federal Way,WA,98003
SBe Address.121 NE Belfair Station Phone: (]53)toe Was ��//''II—r
Pa.]Number, 12328-51-WI26 Permit NumbaG � 00 I IP
Part 2:Sewer System Information 1
Name of Sewer System' &lhb [d Site Plan attached?
OMetaf use only: Sewer System Managaror OeslgmW Employee is W complete.
NewC Co�Mn M1an,evMwai lM1eeWaanb in(wmeNm eM hnw lw ifsueewEi Meson CwNy Pudk HetlN apgvNg ale wrtespa 9n9
Meson wnly PrmL
❑ UWWICom,ermrt IM1eue ronewaE Me eppfunb lnfama4on antl Nye ru lmueslWO,Megan Caunry Puhri HeelM epp,wmg Me
."Was Mawr CwMy Pvrnt
- ,❑y I lava revkweL Ne weanis N nwaon aM Mw ftkasnetl sew whintlknm ormv NOT avWaba m this popery
ep f1o®eM lM bbwNp aMti .)—a,e mne '.Mawr c—W.(apa y
Must meet all Mason County design and construction standards, must pay all fees
inducting:connection fee with permit and inspection fee,and Latecomers charge(TBD).
Richard Dickinson 11023
rwees N.�asr.un w.a.,r E,rey.. swWaasrNea M�ywaiebyw oM.
Part 3: Mason County Public Health Reviewf Approval
❑ Samfactory ❑ unsatisfactory
sq�phnea EMwlymMa HeeMl sp,mex cue
This form may be scanned and available for public view on the Mason county Web Site.
a case 7