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HomeMy WebLinkAboutBLD Sewer Adequacy - 7/26/2024 SONcovN�'� RECE PublicHealth 29 2024 Always working for safer healthier Mason County 615 W. Alder Street 415 N.6th Street,Bldg 8,Shelton WA 98584 360427-9670 or 360-275-4467, extension 400 Application for Determination of Sewer Adequ"VIRONMENTAL Instructions: HE 1. Complete Part 1 of application. Permit number may be added at later date. 2.Take application, Site plan, and any other associated information with the proposed development to the Sewer System Manager or Designated Employee for approval. 3. Submit Completed application and information 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 lines in relation to proposed development and property. Part 1: Applicant/ Parcel Information Applicant: OLDS, Aaron & Kathleen Date: 7-26-2024 Mailing Address: 12820 SW 18TH ST City, State, zip: BEAVERTON OR 97008-4623 Site Address: 343 E POINTES DR E Phone: (360) 359-2967 (, 2 Parcel Number: 12119-50-00104 Permit Number:i' Da uq -' (^1� o 70 C J Part 2: Sewer System Information Name of Sewer System: HARTSTENE POINTE WATER-SEWER DISTRICT ❑ Site Plan attached? Official use only. Sewer System Manager or Designated Employee is to complete. ® New Connection: I have reviewed the applicants information and have no issues with Mason County Public Health approving the corresponding Mason County Permit. ❑ Existing Connection: I have reviewed the applicants information and have no issues with Mason County Public Health approving the corresponding Mason County Permit. ❑ I have reviewed the applicants information and have determined sewer connection is currently NOT available to this property ❑ Please add the following condition(s)on the corresponding Mason County Permit: (optional) Jeff Palmer, General Manager { - 7-26-2024 Pnn=Name or System Manager/Employee Signature a system Manager/Employee Data Part 3: Mason County Public Health Review/Approval n W, li!l I,�� l�l Satisfactory ❑ unsatisfactory {�`ofEJy 1_ Signature of Environmental Health Specialist Date This form may be scanned and available for public view on the Mason County Web Site. nuISED mrzerzms