HomeMy WebLinkAboutBLD Sewer Adequacy - 10/28/2016 RECEIVED
OCT 28 2016
MASON co.urLLITWs
RECEIVED �(;®ry
UU1 18 2016
615 W.Alder Street Public Health
Ahwts vrorlle0 fur a as healthier Ne.0ounty
416 N.6h scale,Us C Shaaan WA a6564
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Application for Determination of Sewer Adequacy
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Part 1:Applicant l Parcel Information 14
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MaIIbOAudness: P•U. lacy, %0 city,StAte.21o: WA 9R4Y1
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Parcel Numbor,l.`7�.3�1—a'I2' 00190 Permit Number:
Part 2:Sewer System Information r
Nana 6f Saver System: C oofu I)" ll2 7.05 I r r Site Plan attached?
Official use only: Sourer Syatonl Manageror Deslgualad Employoelstocomplefe.
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Part 4:Mason County Public Health Review/Approval
❑ Selisfaclory ❑ Unsatisfactory
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This form may be stunned and evallable,for public view on the Mason County Was Slla
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