HomeMy WebLinkAboutBLD Sewer Adequacy - 8/23/2023 I
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Application for Determination of Sewer Adequacy
Instructions:
=appI1ca6. Sjw
Part t of application. Permit number may be added at later date.
lca6. Site plan,antl any other associated information with me proposed development to the Sewer
ager or Designated Employee for approval.
mpleled application and information to Pernik Center or Mason County Public Heafth for revi"..
must supply full System Manager with a site plan for the project,showing all existing or proposed
ponents and lines in relation W proposed development and property.
Part 1:Applicant I Parcel Information
Applicant Sam Martin,Agent for Lentrar Northwest,Inc Date: 8/23/2023
Mailing Address: 33455 6th Ave S,Unit I-B city,state,ziP Federal Way,WA 98003
SI1e Address: 16aNEOlymPkaWSa Phone: C53)294-1322
Parcel Number. 1232151-MI32 Pemtlt NumbenU✓�((TSL_—
Part 2: Sewer System Information
Name of Sewar SysOsm: adra, Ni Site Plan attached?
official use only: Sewer System Manager or Designated Employee B fo Complete-
CM Neaconned'on'. IM1ave revlewea uwaFpfranta Mlamellon ens M1ave MlawuwN,Mavonownry Puhac HeN,eppmMm lM1a mNeapoMlnB
Masan eouMV PMmM1.
❑ Exflmcannadion'. IM1eva mMavea Ne eppticenb inlomwtlon antl M1avaml5suuwlN Meson County PublaHwM,apPmvin9 tle
mNeaPonab6 Meson CaunM Pemtll
inaya raulwrytl Ne epplicenb lMwmeYM eM M1eve eelermmed eewerxnned'unbblaedlY NOT auaaadeb ll,bpareHy
gfPlease ant Nis ldlwvFe 000, n(a)on Un caraapoaal,p Munn co"Pe1Ml6o0 0
Must meet all Mason County design and construction standards,must pay all fees including:
connection fee with pearm and inspection fee,and latecomers charge(TBD)
RMIeJ Name W6rdMMSYWa EMp'Waa aam4edaYMa�nrLn4eFn6Ma4 sent
Part 3: Mason County Public Health Review/Approval
❑ Satisfactory ❑ Unsafiaaclory
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This form may be scanned and available for public view on the Mason County Web Site.
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