HomeMy WebLinkAboutBLD Sewer Adequacy - 6/13/2022 MASON C0jjV A
Public Health
Always working for a safer heaahier Mason County
415 N.6N Street,Bldg 8,Shahan WA 68564
360-427-9870 or 360-2]5d18],extension 400
Application for Determination of Sewer Adequacy
Instructions:
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 i Parcel inforrnation
Applicant. Harbor coalition Development Inc Dale'. 06/13/2022
Mailing Address: 1201 Pacific Ave,Ste 1201 City, State,Zip: Tacoma,WA 98402
Site Address: 83 NE Ridge Point Blvd Bell it 98528 Phone: 253-649-5216
Parcel Number: 123285000003 Permit Number: COM2021-00024 (Rec Bldg)
Part 2: Sewer System Information
Name of Sewer System: ❑ Site Plan attached?
Oftlal use only: SewerSysbm Manager or Designated Employee is to compNb.
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Part 3:Mason County Public Health Review/Approval irs 12Z.
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This form may be scanned and available for public view on the Mason County Web She.
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