HomeMy WebLinkAboutBLD2004-01862 - BLD Water Adequacy - 12/14/200411,Dec.14. 20041 2:19pM;3427WINDERMERE/H1M-I
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
Environmental Health
C
Application for Dete
Le `c v '1' " t-‘1 No .4623
2/332
PO BOX 1666 SHELTON, WA 98584
LOCAL (360) 427-9670
BELFAIR (360) 275-4467
nation of Adequacy FAX (360) 427-7798
Instructions
1;Eonipletei'att 1. No.4eten natioirearibe.road anti' Part,:I. ':*6
2:. Complete only the portion.o :402 pp g to,t1 c t of:water stet!
3.. . Sabinittnmmleted applieationiviith,a#tac}fm..I pro tea tit d+
PART 1: Applicant/Parcel Identification
Name of Applicant Ben Ramsfleld
Mailing Address 1664 Comae LN SW #302 Tumwater WA 99512
Assessor's Parcel Number 32008-76-90014
Type of Water System (Check One):
0 Public/community water system (2 or
more connections)
❑ Individual well (one connection)
Q Well
❑ Spring/surface water
❑ Other (explain)
Date 11/17/2004
Telephone (360) 791-6691
Reason for .alp, plication (Check One):
L!!.J Building permit
0 Land use application, if so...
o Division of land
# of parcels?
SPH2_
❑ Boundary line adjustment
❑ Other (explain)
PART 2: Water System Information
Complete the section appropriate for the type of water system being evaluated for adequacy:
Public Water System
Name of Water System Cardona Water uj QST
Water Facility Inventory (WFI) Number. 3 33 0
El The water purveyor has filed a letter granting blanket hookups to this water system.
I aro the mans e.r of this water system. The water system ba been approved for 6 services. There are
presently . connections muse. This wit n e the (n connection. 'Ibis water system is able and
willing to providc water to this (these) conn ns without e4eeding the limits of the water system or any
limits set by state and local regulation. I
Signature of Water System Manager
Date 11. I 1
Updaw March 22. 1999