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Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pan 1 of application. Permit number may be added at later date.
2.Take application,Site plan,and any other associated information with Me proposed development to the Seeer
System Manager or Designated Employee for approval.
3.Submit completed application and information to Permit Center or Masan County Public Health for review.
NOTE:you must supply the System Manager with a site plan for the project,shaming all existing or proposed
sewer corn Portents and go"In retatlon to proposed development and property.
Part 1:Applicant/Parcel Information
Applicant MITT CONSTRUCTION Date: 9/62024
Mailing Address: 16000 Christensen Rd Ste 150 City,state,ap: Tukwila,WA 98188
Site Address: 91 E COMPASS LN phone: 253-508-2156
Parcel Number. 12220-50411002 Permit Number :61d Z0 2 " Q 1 Iql
Part 2: Sewer System Information �/
Name of Sewer system: North Bay Case Inlet L7 She Plan attached?
OMdeial use only: Sewer Syafem Manager or Deslgnated Employee B O complete.
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Must meet all Mason County design and construction standards,must pay all fees including:
connection fee with permit and inspection fee,grinder pump fee(if applicable).
Richard Dickinson
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This form may be Scanned and available for public view on the Mason County Web Star.
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