HomeMy WebLinkAboutBLD CD Environmental Health Review - 9/18/2024 812975
115 N.M STREET,sloe 9,SHELNH W16aS06
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MASON COUNB,UX .
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COMMUNITY SERVICES EL weNbM'W4w
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Application for Determination of sewer Adequacy
Instructions:
1.Complete Pad I Of application. Permit numoer may be added at later date. seed development ro he Sewer
2.Take application,Site plan,and any other associated information with the Prop
System Manager or Designated Employee for approval.
3.Submit completed application and Information to Pemlil Center or Mason County Public Health for reties.
theS slam Manager vdlhashe Plan for the pmfec%showing it eyj gng or proposed
NOTE:You must supply Y 9
sewer component and lines In relation to proposed development and property.
Part 1:Applicant I Parcel Information Data: 9I1612024
Applicant MTT CONSTRUCTION Tukwila,WA 98188
moing Address: 16000 Christensen Rd Ste 150 city.gone.Zip:
Phone: 253-508-2156
SlsiteAddre 51 E COMPASS LNss:
Parcel Number 12220-50-61005 Permit Number.
Part 2:Sewer System Information ESita Plan attadh 7
Name of saver System:North Mason Case Inlet
Manaflar or Daslgnarod Employee Is m complete.
official use only: Sower Sysram HeMlh eoMadm lM�nwoi°na
q tyw CpineeW: IM1ere rwMeL Ne.GW.e'e lnlnnuYonud Nve roNeuesvMM1 Meem Ceur'+/I+uEXe
A.CmT1Y Pornil.
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.Ini N gMunnconn antra
❑ IpuluyeyaiYaPWYyne Y,danda ,and heu saddra dd°°aer wnnW n a Mmey NOT ardilade Id atls gcpnr
e Fla...e ee rar ' enalodMal on We ddddp qhO Masan cu Fdnnit fwrru"n1
Must meet all Mason County design and construction standards,must pay all fees including:
connection fee with permit and inspection fee,grinder pump fee of applicable). _
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Richard Dickinson pen
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Part Mason County Public Health Review/Approval I 1 '��aM
Satisfactory ❑ unsatisfadory alanaheed Ere —n alH Ire slxdadt
This form may be seen oel and available for public view on the Mason County Web Site. aeaewvnw.