HomeMy WebLinkAboutBLD Sewer Adequacy - 8/21/2024 IDoS� �
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Always working althier Mason County
MWII9�� 415 N.6N Stmeu Bldg S.Shelton WA96564
360427-9670 or 360-V5-446T,extension 400
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Part 1 of application. Peril 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 project,nter or Mason f showing County Public
Health for review.ierroosed
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NOTE:You must supply the System Manager with a site plan for the roect, 9 g
sewer components and lines In relation to proposed development and property.
Part 1:Applicant I Parcel Information 8/21/24
Applicant: Aschlee Heiny&Jacob Heiny Data,
Mailing Address:
7550 Roosevelt Ave Sw city,state,Zip:Port Orchard,WA 98367
Site Address: 460 E Lakeshore Dr,Allyn,WA 98524 phone: 360-633-9394 I
Parcel Number.12220-54.00043 Penh Number. biiju D1
Part 2: Sewer System Information
Name of Sewer System: tJ bic \ �i P� a�g T
official use only: Sewer System Manager or Designated Employee is to complete.
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Mawr county county Permit
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Part, : Mason County Public Health Reviewl Approval
Satisfactory ❑ Unsatisfactory slgeelursorEml nodHearm speuewl a 4au
411-f rl rA�n JA Cl 4 -
This form maybe scanned and available for public view on the Mason County Web She.
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