HomeMy WebLinkAboutAPPLICATION FOR DETERMINATION OF SEWER ADEQUACY - BLD Sewer Adequacy - 3/3/2025 400082
415 N.BTH STREET.RLW 6,SNELTONM 011564
MASON COUNTY SHELTON:3M0.121iaID,E%T IW
COMMUNITY SERVICES aELGaa:550.na11aT.EAT too
ELMIv'a9a�192-5259,ExT Ioo
bell Na-ft.I.—I.,R.Ph'CommmbY NeYL FM:350.e27-0I95
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 for review.
NOTE:you must supply the System Manager with a aim plan for the project,showing all existing or proposed
sewer components and tines In relation to proposed development and property.
Part 1:Applicant I Parcel Information
Applicanl?2indy Callaghan/GreenbergFarrow Date: 2/4/2025
Melling Address:5938 Sandhurst Ln.#205 Ctty.Sbm,2lp.Da11as,TX 75206
Site Arithmetic 23940 HE SR WA-3 Belfair Phonate 502-299-7180
Parcel Number 12329-41-90230 Permit Number. TBD
Part 7:Sewer System Information
Name of sewer system: Belfair Sewer site Plan attached?
Official use only: Sower Syalem Managaror Daspgmafed Empleyss ism complete.
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A modification fee of$35 is required.
Richard Dickinson GGZdY--L.PS
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Part 3:Mason County Public Health Revlewf Approval
I�Satisfactory ❑ Unsatisfactory IWC�IYI, ye P 1 7/
TT 919,WUA eIE nW HeNN$peaMbl MM
This form may be scanned and available for public vlae,on the Mason County Wab Site. :
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