HomeMy WebLinkAboutBUILDING A - BLD Sewer Adequacy wild IV unU4--Z)
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Public Health
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415 NAM Strait Bldg 8,Shefton WA 985M
3 27-9670 or M0-275 7,extension 400
Application for Determination of Sewer Adequacy
Instructions:
1. Complete Pan 1 of application. Permit number may be added at later date.
2 Take application,Site plan,and any other associated information with die proposed development to the Sewer
System Manager or Designated Employee for approval.
3. Submit completed application and information to Permit Center or Mason County Public Heath for review.
NOTE:You must supply the System Manager with a site plan for the project showing all existing or proposed
sewer components and lines in relation to proposed development and property.
Part 1:Applicant I earcel Information ����� �L�
Applicant }- III Date:
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She Address: I AE Tf rIhone: ea5S OUL19 "0UW
Parcel Number WAVLA- -0=o3 Permit Number. 0,0M 202-1 - 600Ia
Part 2: Sewer System Information (,
Name of Sewer System: r/.I ) ❑ She Plan adadh sd7
Official use only: Sewer System Manager or Designated Employee Is to complete,
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Maven County PartnK
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mrnonormng Mason C W Perm,
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Part 3: Mason County Public Health Review/Approval
❑ Satisfactory ❑ Unsatisfactory
s"ahae a FSWmnmeMel Health specialist call,
This form may be scanned and available for public view on the Mason County Web Site.