HomeMy WebLinkAboutbld2020-01048 - BLD Sewer Adequacy - 9/11/2020 ENVIRONMENTAL RECEIVcD
HEALTH OP-5Qea eov'v?. SEP 11
2020
PublicHealth 615 W:Alder Street
Mways waddle fora safer healthler Mason County
415 N.6Ih Street aNp a,SheMon WAN5a4 - -
36D.427-5670 er 360.2754167,wnersion 400
Application for Determination of Sewer Adequacy
Instructions:
1.Complete Pad 1 of application. Permit number may be added at later date.
2.Take application,Site plan,and any Other associated information with the 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 Health far review.
NOTE:You must supply the System Manager with a site plan forthe protect,showing all existing or proposed
sewer components and lines in relation to proposed development and property.
Part 1:Applicant!Parcel Information
Appucaoc Cedarland Homes, LLC Date: 812612020
Mailing Address: PO BOX 2264 city,stale,Zlp: Gip Harbor,WA 98335
Sae Address: Block 60, Lob 9 Phone: 253-20MI36
Parcel Number. 12220$0-00009 Permit Number.�60 2.620 — b I 0`-1 a
Part 2:Sewer System Information 7
Name of Sewer System: 1j ,� 1 ❑ Site Plan attached?
Otficroluse only: Sewer Sjnlem Manager or Drnlgnelad Employee is to templet,
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Part 3;,Mason County Public Health Review/Approval
11W-/Satisfactory ❑ Unsatisfactoryas
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This form may be scanned and available for public view on the Mason County Web Site.
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Printed from Mason County DMS
Printed from-Maser County OMS