HomeMy WebLinkAboutWAT Application - 4/14/2020 �y�tio2o,000u 3
RECEIVED
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Application for Determination of Sewer Adequacy
brsfmctions:
1.Campkte Part t aapplication. Perron numbar may be added at later date.
2 Take application,Site plan,aM any other associated nfmmalion Wdh the proposed deveopmeot b the Sewer
System Manager or Designaod Empbyee for approval_
3.Submit complehn!application and informa8on to Permd Carder or Mason County public Health for review.
NOTE:You must supply the System Manager with a sits plan for the project,showing all existing or proposed
sewer components and linos in relation W proposed development and property.
Part 1:Applicant 1 Parcel Information
Applicant: DM Belfair Investments II LLC Data: 3/18/20
Mamnga mss: PO Box 217 Cih,Stain,zip- Fox Island WA 98333
Sita Address: 31 NE SR 300 Belfair 98528 phona: 253-649.4459
Parcel Number. 12329-42-00190 Permit Number.
-- Part 2:Sewer System Information
Nana of Sewer System Mason County Utilities acct#400096 ❑ Site Plan stlach d'!
Omelet use only: SewerSysfem Manager orOesignated Employee lsb complete
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Part 3:Mason County Public Health Review/Approval
❑ Satisfactory ❑ unaawaclory
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This form may be sranned and available for public view on the Mason County Web She.