HomeMy WebLinkAboutBLD Sewer Adequacy - 11/7/2023 400515
415 N.6TH STREET,eLOG S.SHELTON Y4kW 64
MASON COUNTY fiHELTON:3aFITP%To,WX 4.
COMMUNITY SERVICES 6ErLuj:aao IszMai,E%T4.
Evwv am�ez-sae.ExT 400
eullElig,vlanNrS EnrannaaMixadh InNerh FAX:Ya4n.'Rea
Application for Determination of Sewer Adequacy
InsWcdona:
1,Complete Pad i of application. Permit number may be added at later date.
2.Take application,Site plan,and any other associated Wcarmaton with the proposed development to the Sewer
System Manager or Designated Employee for approval.
3.Submit completed appliration and information to Permit Center or Mason County Public Health for review.
NOTE:You meat 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 Lauren Fafnis Agent for LenaarNorthwest,Inc Dare: 11/7/2023
Mailing Address: 33455 6111 Ave S,Unit I-B city,Slob,zip: Federal Way,WA 98003
Sae Address:420 NE Ridge Point Boulevard Phone, (ss6)aaeL2e6
i Faecal Number.
IMUS-51-e0141 Pafthl tier Rl> D DPI_ -t7MI9
I
Part 2:Sewer System Information
Name of Sevw(System: act"' 10 she Plan albched7
Ogfelei use only: Sewer System Manager Designated Employes is as COMPlate.
pee'Gwna[IIM l hM,erM'.eE IN appRcaMe InbmnTvi aM Nve no IewmanM MafcncoaNy PNNb 1bYN aWmekY tlsmngarcMp
Munn(bwrtY Pwttil.
(y,�gCon�eron: INw,mier"'"n- -on lnbmwllvnaM Nw Nlaswe MY�Memn Gounry PWY HwM ap BD IN
mnulp,ryg Maem Gunly Pemil
❑ INre[mlaweil Te appewe¢Inlgmaem aM lwaCMemmnaa serer connatllma px�eney NOTaralbbkk NbpcpmlY
PbaN em IM1e Iceuv6y cwsl4ml¢)m cis wrte¢WMlne Mewn Cmrq Pxmlt(M4antm
Must t II M county des' tl construction st pay all fees _
including connection fee
with per it d pecti (fee,a d latecomers shame CfBD). _ _
Richard Dickinson _ 11923
pNa.�¢Neasrpw M.w.reiNpe. aa.v.wsr+.a M..weempr
Part 3:Mason County Public Health Review/Approval
0 Satisfactory ❑ Unsatisfactory sigmiu,e a Ervrarmanw xern spawest cow
This form may be scanned and available for public view on the Mason County Web Sea.
aeaamwnw>