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Home My WebLink AboutBLD2026-00320 - BLD Sewer Adequacy - 5/12/2026 SON CO Public Health Always working fora safer healthier Mason County 415 N.6th Street,Bldg 8,Shelton WA 98584 360-427-9670 or 360-275-4467,extension 400 Application for Determination of Sewer Adequacy Instructions: 1 Complete Palt 1 of application Permit number may added at later date 2 Take application,Site plan,and any other associated information with the proposed development to the Sewer System Manager oi'Designated,Employee fot approval 3 Submit completed application aid information to Permit Center or Mason County Public Hey ith for review NOTE You must supply the System Manager with a site plan for the project,showing all a lsttng or proposed, sewer cortponents and limes in relation to proposed development and property. Part 1:Applicant/Parcel Information Applicant: Frio nnri Rirharri I amr iir Date: 3/15/26 Mailing Address:7318 Deerfield Park Dr NE City,State,Zip: Olympia,WA 98516 Site Address: 374 E Pointes Dr E Shelton WA Phone: 503-505-3031 Parcel Number: 12119-50-00155 Permit Number: BLD2026-00320 Part 2: Sewer System Information Name of sewer System: Harstene Pointe Sewer-Water District E Site Plan attached? Official use only: Sewer System Manager or Designated Employee is to complete. New Connection: I have reviewed the applicants Information and have no issues with Mason County Public Health approving the corresponding Mason County Permit. o Existing Connection: I have reviewed the applicants information and have no issues with Mason County Public Health approving the corresponding Mason County Permit, O I have reviewed the applicants information and have determined sewer connection is currently NOT available to this property. (] Please add the following condition(s)on the corresponding Mason County Permit:(optional) ,JEFF 31 �ZA2 Printed Name of System Manager/Employee ature of System Manager/Employee Date Part 3: Mason County Public Health Review/Approvalr` t)t'1 5/12/26 fJ Satisfactory ❑ Unsatisfactory Signature of Environmental Health.Specialist. Date This form may be scanned and available for public view on the Mason County Web Site. REVISED 1012&2015 3