HomeMy WebLinkAboutBLD Sewer Adequacy - 9/17/2024 812973
415 N.and STREET.BLDG e,SHELTON YMm59<
sHELTOR:aep ,EXT4CD
MASON COUNTY
BELFNfl'.M6VII5A4STY1e6T.E%T 100
COMMUNITY SERVICES E w ...els"..EXT.".
eullSnp,ihniina EarvYmmmlalNeallF.GmmwnYHaaltn FN 1.27-W"
Application for Determination of Sewer Adequacy
Inswcaons:
1,Complete Part 1 of application. Palmit number may be added at later date.
2.Take eppllcOOn,Site plan,and any other'ancestor Information with the proposed development to the Sewer
System Manager or Designated Employee for approval.
3.Submit completed applicalon and Information to Permit Center or Mason County Public Health for revle ..
NOTE:You must supply the System Manager with a site plan for the project,showing all a%lating or proposed
sewer components and lines In.1800.W proposed development and property.
Part 1:Applicant I Parcel Information
Apploem, MITT CONSTRUCTION Dam: 9/17/2024
Mailing Address: 16000 Christensen Rd Ste 150 City,State,zip: Tukwila,WA 98188
Site Andres, 71 ECOMPASS LN Phone' 253-508-21566
Parcel Number 12220-50-61004 Permit Number. I C 1 b( ' AI
Part 2: Sewer System Information
Name of Sewer System:North Bay Case Inlet �se Plan attached?
Official use only: sewer System Manager or Designated Employee Is to compNte.
aE NewrpVwdprt I hoe uwb IM eµenNoW MhYm04oneM NeW no'osuea wm'C counly Pudic HeeINeww.the-n'PMdlq
eP Me.county Pan,
EaiaWeCPnns'fkrt 1Nw raYlw.eE wa aPPWnb InMncllonaM Nverolouse M.Mee-I.,11ok HN epPlwietlw
couae H,Mean cbm1Y FamiL
.❑ Ilwer Wre asps W-1-sM lwue dNmadmdea'a.<rourawcMm is-n-M'NOT evtlbde b Nb rr-anY.
Ip Pleer e]E lln rolUwlM mN%Y(aJ an aa-Ir-penelM Wa-Gwnly Pemdt loplMua
Must meet all Mason County design and construction standards,must pay all fees Including'
connection fee with permit and inspection fee.grinder pump fee(8 applicable).
Richard Dickinson /� 5 d Az
r—T ow
PM1YW rvvrw a9)tlam MSWan EnWaa &aw'ang5Y4MNeNYn EmgaM
Payin 3: Mason County Public Health Review/Approval It ri Lf ('Z4
Satisfactory ❑ Unsatisfactory aatinve-f er"J.-__._ry H h sp .W
This form maybe scanned and available for public view on the Mason County Web Shia. een—vum r