HomeMy WebLinkAboutBLD Sewer Adequacy - 9/11/2020 (2) ENVIRONMENTAL
HEALTH
Public 'Health RECEIVED
Always waking for a safer healthier Mason County
415 N.dth Street Bldg B.Shelton WA985M SEP 11 2020
3coe27-9510 a 360275 7,eatemlon 400
Application for Determination of Sewer Adequacy W. Alder Street
Instructions:
1.Complete Pan 1 of application. PennB number may be added at later dale.
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 Heaflh for review.
NOTE:You must supply the System Manager with a site plan for the project,showing all exisnng or proposed
sewer components and lines in relation to proposed development and property.
Part t:Applicant/ Parcel Information
Applicant Bak ack Holdings LLC Date: 812612020
Maiing address: PO Box 2264 city.stale.zip: Gig Harbor,WA 98335
Sae Addmss: Block 60, Lot 7 Phone: 253'-�2j08JJ-81n36w ^ ��-Ti
Parcel Number: 1222050-6OW7 Permit Number. DI(- 26W —0I01
Part 2: Sewer System Information!?
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Part . Mason County Public Health Review/Approval
Satisfactory ❑ Unsatisfactory
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This form may be scanned and available for public view on the Mason County Web Sae.
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Printed from Mason County DMS
Printed 19m Mason County DMS