HomeMy WebLinkAboutBLD Sewer Adequacy - 9/17/2024 812976
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Application for Determination of SewerAdequaly
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Inavuctlona:
1.Complete Part 1 of apPliraao^. permit^umber may be added at later dale.
2.Take application,Site plan,end any other essotietad information vAth the Proposed development ro the Saver
Syslem Manager or Designated Employee far approval.
3.Submit completed applice5on end infoimakon b Peimh Center or Mason County Public NeaIN for review.
NDTE:You moat supply the System Manager with a alto plan for the protect,ahowin9 all evlagng or proposed
sewer components and lines in relation to proposed davelopmeM and Properly.
Part 1:Applicant Parcel Information Date: 9117/2024
Applicant MT CCONSTRUCTION WA 98188
Malin Am : 16000 Christensen Rd Ste 150 city,State,zip: Tukwila,
41 E COMPASS LN phone: 253-508-2156
Site Address:
parcel Number. 12220-50-61007 Permit Numb 20zaE � 1 /I b I I
Part 2:Sewer System Information D/Ske plan agachadl
Name of Sewer System:North Bay Case Inlet
official use only: Sewer System Manager of 0ea19natod Employee 4 W complete.
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Must meet all Mason County design and wnsiruction standards,must pay all fees including:
connection fee with permit and inspection floe,grinder pump fee(if applicable).
Richard Dickinson od.
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Pa 3Satisfactory ❑ Unsa:Mason County Public Health Reviewl Approval A ,3a1`nn7 '1'4�
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This form may W scanned and avall.bt.for public view on the Mason County Web Site. '