HomeMy WebLinkAboutBLD Sewer Adequacy - 9/17/2024 812979
415 N.aTH STXEEE BLDG a.SHELTON YMasaN
SHELTON:16GAV-sam E ..1w
MASON COUNTY BELFNR:.Pater.UT 4M
COMMUNITY SERVICES e.M 6a82,,sa.EXT4m
FAX:3W4n.2795
nWltllna NnNV EmaorvneNalNeJN.Tnmm.Mly-1.1
Application for Determination of Sewer Adequacy 10
Inatrucnans:
1.Camplele Pan 1:r,d:lh
on. Permit number may be added al Ie1M tlak. development to the Sewer
2.Take application, and any other mwa tad informed-with the proposedSystem Manager od Employee for approval.3.Submit completen end Infonmagon to Pennil Cemer or Mason Counry Publk Health tar review.NOTE:You must System Mons gar��Evplanfortandrpmperty.wing alleXlagng orpmposedsewer compomma in relation to p P
Part 1:Applicant I Parcel Information Date: 9/17/2024
Applicant:MTT CONSTRUCTION
Mailing Address: 16000 Christensen Rd Ste 150 City,state,Zip:Tukwila,WA 98188
11 E COMPASS LN Phone: 253-508-2156
site Addmss - d
parcel Number. 12220-50-61010 Permit Number: ?�I
Part 2: Sewer System Information U/Site Plan attached?
Name of Sewer System:North Ball Case Inlet
011ktel use only: Sewer System Manager or Designated Employee Is m comPNae.
.� .Cmne'JaK lhM min'aJ Vw egYc°^n lnlmmeaan echewrvawwwiN Memn UUMY Fudk Heats aMno+I�Nl aefu„espoMlnp
Newn Wuntr PMML lMeonCwnd DIpIb HWM
El E eppmWm em
,r,connaCan: Ilww nNexeCIM eDDrNnd hkrmeYonup Fauera lnuesMN
cp. p W.CmvXY Pe
❑ Ir+..mW.�tlu++DNa�uld=^"'^°"•"tlnm.e.n.nmaew,wm.eWknu wlra,ln narmu.bleaula wexm.
lg Wen WkNtlbwlne wlNbMe)m Me mnewdklny Mwoa ewro Penml'ta'✓n*"%a
Must meet all Mason County design and construction standards,must pay ell fees including:
connection fee with permit and inspection fee,grinder pump fee in applicable).
Richard Dickinson
gryEae p SYawn Ys4tl Em{YMe
gyAM Xumd9/aWmdNoatla'M°n^° ,,�^n^/^1 /�,(�I
Pa��aaaaaaaaaat[[[3��v:Mason County Public Health Reviewl Approval
�Y1d Ann.n�V• 1 �' I�y{I✓J
Sallsfactory [Isq
Unsatlafaciory .durod Eld•a'1
I iI!
This form may he scanned and available for public view on the Mason County web Site. ecesc.11