HomeMy WebLinkAboutBLD Sewer Adequacy - 9/17/2024 812978
415 N,Ma,,EU,,Kos a,SHELTON w 955&
SHELTON:]&<3T-aSTo,IXL"'
MASON COUNTY aEIEMa:5e0.95�4m.UT<ao
COMMUNITY SERVICES EadhM"&,5iSaExT400
eaal�N,n.mm�aon+^^i^°^ulx.aun,�m�.+ryxolln
rnx:saoan-nee
Application for Determination of Sewer Adequacy LO4-q
InaWctlonw
t Complete part 1 of application. Permit number may be added et later data, tlevelopmenl to thAS�r
2.Take appliwgon,Sim plan,and any othermeomnedInformation with ate proposed System Manager or Dasignsted Employee for eppm,ml.3.Submit completed application and lnfamatlon to Permit Center or Mson Coo ahowing fty public fillexisd g
NOTE:you mwtsupply the System Manager with a site plan for the project,
sevrer component and lines In relagon W proposed development and property.
Part 1:Applicant I Parcel Information Dete. 911712024
Applicant MTT CONSTRUCTION
Mailing Address: 16000 Christensen Rd Ste 150 City,state,zip: Tukwila,WA 98188
site Address. 21 E COMPASS LN phone: 253-508-2156 _61I I �J
Parcel Number 12220-50-61009 Permit Number.
I?,1 it r1A`t
Part 2:Sewer System Information Ly Slta Plan anached9
Name of sewer system:North Bay Case Inlet
F[:.C
Ny: Sewsr System Manager or Daslgnated Employeeisrocamplate.Mclen i hee rml HIC eWlY lnaimMle ea hit m beerwithM'.W PMra.Yp Meson C uo my E Yre appinnls I,Am+bnend heremWwaNPIm0lbn yq agar connetav�laaimMN NOi avNMHe bINSPro9adY
riew tits aPpSaentatit rci, Ang oaAdpO{s)on lit ca�wPe"o eeun"b .:d.0meat all Mason County design and wnstrucgon standards,must pay all fees induding:
ection fee with pemiit and inspection fee,grinder pump fee(if applicable).
Richard Dickinsonn.n.ap.NmwotEmpaYe
sgwu.d eve"^weaesp G,pavae
Pa Mason County Public Health Review/Appr
oval
.$a65faClOfy ❑ Ilnaatimadely ggneyro d EmtieM1mMOH IN speoabt
7 pets
a4-mckacra.,
Thle form may be scanned and available for public vlaw on the Mason County Web Sae. mar®vmmr