HomeMy WebLinkAboutBLD Sewer Adequacy - 8/15/2024 A-001 of
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Application for Determination of Sewer Adequacy
InstmCtioni
1.Complete part 1 of application. permit number may be added at later data
2.Take applicator,Site plan,and any other associated information with the proposed development b the Sewer
System Manager or Designated Employee Air approval.
3.Submit completed application and infor nellon to permit Center or Mason County PUNic Health for review.
NOTE:You must supply the System Manager with a site plan for the project,showing as existing or proposed
sewer components and lines In relation to proposed development and property.
Part 1:Applicant/Parcel Information ..``
Applicant: Case: 8I JY latk
Mailing Address: (1 City.Slate.2b:ydnre s`/, t ` Cjb-[{a(n
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Parcel Number: t'.,1`A'ALA 'ltM�n Parma Number:Wa• xaUOM—CCCyP,
Part 2:Sewer System information
Name of Sewer System: _l t'r ❑ Site plan atlachseen
Olflcial use only: Sower Sysrom Manager or Des/grulad Employes is rocomplero.
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Part 3:Mason County Public Health Review/Approval
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This form may be scanned and available for public view an the Mason Caen, 1S�M .Q rP4
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