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Home My WebLink AboutBLD2005-02134 - BLD Application - 12/18/2005 RECEIVED �^ FORM MUST BE COMPLETEPU N INK MASON COUNTY PERMIT NO. ' dV C) PLEASE PRESS HARD q§UWDING PERMIT APPLICATION 426 W.War- P.O. Box 186, Shelton, WA 98584 Pr �3 )4K0 - Belfair(360) 275-4467 - Elma (360) 482-5269 l k5--- On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Li n AA K o i phi Company Name Mailing Address IoBI Kamm. Dr Mailing Address City c L510-na State W A Zip Code O&S-g City State Zip Code Phon 2s!1)S10-.2-t 4 a Other Ph 3 S'f - hone Other Ph. Lien/ itle Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# ►I DOB 2- Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well y" Sewer System rr Name of Sewer System o Ila I& OOU PARCEL INFORMATION - 12 Digit Parcel No. r - - bo Fire District Legal Description I+v ofi lip , h� -I "o. "2m Site Address(Please include street name, s reet number and city) Bel & Directions to site �'�` " nafih I ntO Cf'b5S Drt�h t rr Will limrber be cut and sold in parcel pre aration?Yes/ o S�'►�yoft GhUaSed Gw �� p► Is property within 200'of Saltwater V Lake River/Creek Pond Wetland Seasonal Runoff Stream lopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New V Add Alt Repair Other PRIMARY RESIDENCE ® SEASONAL ❑ Use of Building ROWW-' Describe Work No. of Bedrooms No. of Bathroom 312 Square Footage- 1 st Floor 17/09&ff, 2nd Floor. s 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage ✓ Attached ✓ Detached w w6arport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF OGRESS PPECTION.IN ACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: 12— 20 Owner/Owners Repres tative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Subrrtittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION C) 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 ! Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us +" APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Li i,diet k ra i 1= 1 i rr Company Name Mailing Address L Li kdadlu.S Car Mailing Address City It ;k LSlanA State WA Zip Code OS193 - City State Zip Code Phony-2 S:7 Cg�� Other Ph'` S4 b Phone Other Ph. Lien/Title Holder IX Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# kQj4gjj5t16& DOB 2 f Drivers Lic.# DOB SEPTIC,/WATER SYSTEM INFORMATION - Connect to New Septic Exi ' Connect to Water System Name of Water System Well V' Sewer System L Name of Sewer System r t h AL,1 "N 'Y U U PARCEL INFORMATION - 12 Digit Parcel No. -21- Legal Description <.t 41 -fr of a Iv1 { eief f cr its , f +T;3+►'-� .22L AJ k'sar►4�. 14�.'. C-1` cvrY1 Site Address(Please include street name, street number and cit " �,✓ St it i ! &'l dr Ix cS. Directions to site "24" nk i#h 4 ClWyr oric) Gr 06.4 CY111 go- C "I, Willi ber be cut and sold in parcel prep ration?Yes/ q 5"A-h e r��. pi'(44 4iw Is property within 200'of Saltwater Lake River/Creek Bluffs Wetland Seasonal Runoff Stream . . lopes or Bluffs 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - Add Alt Repair Other PRIMARY RESIDENCE ® SEASONAL ❑ Use of Buildi g escribe Work ' No. of Bedro of BathroomSquare Footage- 1st Floor /7r� t• 2nd Floor �y y Sg� 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage ✓ Attached ✓ Detached ��t'Carport ''� Attached Detached `! i MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. 'ANo. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ ,-Replacement Unit? Yes/No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaar to information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I,d,�ale tha�I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to de,the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required f? Yn any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null&void if work or authorized construction is i not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY I MEANS OF OGRESS IN PECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: Owner/Owners Repres tative/Contractor (indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department alA / Into Environmental Health Department Fire Marshal FEES Buildinq Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. �a7 BUILDING PERMIT APPLICATION (j 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us ' APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Lt n Aa k n i j2he.C Company Name Mailing Address I f5 i ka w"A De' Mailing Address City x LSya n State WA Zip Code 013'93 City State Zip Code Phoni.2 1�!Z,00.2a M Other Ph' K" - Phone Other Ph. Lien/Yitle Holder Contractor Reg.# Exp. E mail address r 1 E Mail Address Drivers Lic.# I i DOB1. Drivers Lic.# DOB SEPTIC./WATER SYSTEM INFORMATION - Connect to New Septic Exisft-SeptiG- --- Connect to Water System Name of Water System Well ✓ Sewer System v' Name of S9wer Rystam Ajocfli4 PARCEL INFORMATION - 12 Digit Parcel No - -K � Fire-District 4 Legal Description 4 w Site Address (Please include street name, street number and cit 'ga�— IF -'%Ak (-+ �ra� , Bel-ra'c , UA !q&� I Directions to site r''14" nP .fh /r1l -s � �.G L Will 1imber be cut and sold in parcel pre aration?Yes/ " + .5`1r+fwh 6rCl ofcd A,w /L 1 p e, Is property within 200'of Saltwater V Lake River/Creek Pond Wetland Seasonal Runoff Stream lopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New V Add Alt Repair Other PRIMARY RESIDENCE N SEASONAL ❑ Use of Building krMe- Describe Work No. of Bedrooms N5No. of Bathrooms 392. Square footage- 1st Fl 17fi)Jdt, 2nd Floor S 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage ✓ Attached ✓ Detached u_) Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name V Certification No. OWNER/BUILDER Acknowledges submission of inaccurate,information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I decla'te'Ihat I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF ROGRESS I PECTION.I CTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WALL INVALIDATE THE APPLICATION. X Date: 1G-�la / ZQeA Owner/Owners Repres tative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APP&OVED DENIED NOTES Building Department D L Planning Department Environmental Health Department LZ Fire Marshal FEES Building Permit Fee 3 3S- Site Inspection Plan Review Fee d1� SCo EH Review Fee Plumbing & Base Fee A0 -t IA4 Planning Review Fee Mechanical & Base fee 350 -f /'a Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee — Pre-Paid at Submittal Valuation $ 1?0 TOTAL FEES MASON COUNTY PERMIT NO. ��_ -'-- " t .. BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360)427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner L i Company Name Mailing Address 3, .;, li 1)r' Mailing Address City ? . = r ' State Zip Code City State Zip Code Phone " ` 4 `+ Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# i r s � ` DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name Asewer Svs_+ten =!--' -�-x PARCEL INFORMATION - 12 Digit Parcel No. r =- Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site Y Yes/:No� rr Ipreparation? e Will timber be cut and sold in ace P . v' Pond Is property within 200 of Saltwater Lake River Creek o WetlandS easonal Runoff StreamSlo es or Bluffs p Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New v Add Alt Repair Other PRIMARY RESIDENCE ® SEASONAL ❑ Use of Building Describe Work No. of Bedroom- No. of Bathrooms - Square Footage- 1 st Floor / ° • 2nd Floor. 'r`t 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage t` Attached t Detached ` Carport Attached Detached ` MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat 777 Purchase Price$ Replacement Unit? Yes/No Installer Name " Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Date: ' Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES Valuation $ FORM MUST BE COMPLETE D*W �'V4A1?ON COUNTY PERMIT NO�U a�5-O ZI31 PLEASE PRESS HARD PLUMBINIOMMNICAL PERMIT APPLICATION 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 �I c� SheltN�iQ4$7<W&Mir(360)275-4467•Elma(360) 482-5269 mm www.co.mason.wa.us APPLICANT 1f&ORM TION . CONTRACTOR INFORMATION Owner i n oLdL, n i Company Name Mailing Addres 1 L4-. ®r-. Mailing Address City state Vlft Zip Code 4?U 33 City Mate Zip Code Phone).L'�-"44- Other SW-kP&6 Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address �00,bl.Zop, E Mail Address Drivers Lic.# /�E3 DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel N . 1= Fire District Legal Description SP Ili) Site Address (Please include street n me, street number and city) o .2f Directions to site 1 7 NA29p 11ortin 1 Is property within 200'of Saltwater Lake River/Creek- Wetland Seasonal Runoff Stream -ell sad Slopes or Bluffs > 15% TYPE OF JOB - Newer Add Alt Repair Other Use of Building Location of Fixtures/Units - 1st Floor. 2nd Floors Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric— LPC Natural Gas_ Heat Pump_ Toilets _ Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater — Propane Tank Clothes Washer / Gas Outlets Kithen Sinks Wood/Gas/PelletStove Dishwasher - — Kitchen Exhaust Hood Hosebibs Dryer Vent I Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL O VNER/BUI SEER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Admowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.ff permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF F CONTINUATION OF WO K IS BY MEANS OF A PROGRESS INSPECTION. / _ X Date: /�-zl 2:eU� Owner/Owners Repr entative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou T e Constr.- Planning Constr.— Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES PERMIT NO. MASON COUNTY PLUMBING/MECHANICAL` PERMIT APPLICATION 426 W.Cedar• P.O.Box 186, Shelton,WA 98584 Shelton (360) 427-9670•Belfair(360) 275-4467• Elma(360) 482-5269 On the web www.co.mason.wa.us APPLICA T INFORMATION . CONTRACTOR INFORMATION Owner �1 n 0 lL 1Sn l ok% Y Company Name Mailin Addres.-g ID6I Die, -Mailing AddrWs City tax 7_K16w�State Wfl Zip Code 3 Cil Mate Zip Code Phone 3�4�.2141 Other Ph�o"t'q3) S"49—k.14-6 Phone - Other Ph. Lien/Title Holder Contractor Reg.A Exp. E mail address E Mail Address Drivers Lic.# I1 B DOB 11/2111?yy Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Di it Parcel = Fire District Legal Description S Site Address (Please include street n me, stre rrumberan .Rt Directions to site oDi f t Is property within 200'of Saltwater Lake River/Creek Pond V4tiand Seasonal Runoff Stream i±9L0z_d Slopes or Bluffs > 15% PE OF JOB - New—Add Alt Repair Other Use of Building ocation of Fixtures/Units - 1st Floor 2nd Floor. Basement Garage Closet { PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric,_-)�_- LPC Natural Gas Heat Pump— Toile s Te of United-*' o. of Units Fees Bathroom Sink �' �+�'��✓ Furna— -e— revna-e Bath Tubs v 3 Healtpirmps Showers ar Spot:Vent Fan Water Heaters ' Propane Tank ^ Clothes Washer Gas Outlets — Kithen Sinks Wood/Gas/PelletStove Dishwasher Kitchen Exhaust Hood I Hosebibs Dryer Vent 1 Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of . such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF F CONTINUATION OF WO K IS BY MEANS OF A PROGRESS INSPECTION. _ X Date: /ea Owner/Owners Repr9lentative/Contractor (indicate which one) ( FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grour)—Tvoe Constr.- Planning Constr.— Planning Department Environmental Health Department FEES Plumbing &Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES 1 MASON COUNTY DEPARTMENT OF HEALTH SERVICES January 06, 2006 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 LINDA KNIPHER Elma (360)482-5269 1081 KAMUS DR FOX ISLAND WA 98333 Belfair (360)275-4467 Case No.: BLD2005-02134 Parcel No.: 122162100020 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Please see comments at the end of this letter. Please call me at (360)427-9670, ext. 554 if you have any questions. Sincerely, Trish Woolett Environmental Health Mason County Health Services Comments: Received a well log and water sample, it is still not clear as to what the well will be serving. We have two building permits for residences and one well? Is this going to be a two party well ? If not which well is drilled? On which lot? Where is well located? It needs to be shown on the site plan. Please clarify. 1/6/2006 1 of 1 BLD2005-02134 MASON COUNTY DEPARTMENT OF HEALTH SERVICES December 30, 2005 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 LINDA KNIPHER Elma (360)482-5269 1081 KAMUS DR FOX ISLAND WA 98333 Belfair (360)275-4467 Case No.: BLD2005-02134 Parcel No.: 122162100020 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Application for Water Adequacy Please see comments at the end of this letter. Please call me at (360)427-9670, ext. 554 if you have any questions. Sincerely, Trish Woolett Environmental Health Mason County Health Services Comments: If both houses are going to connect you will need a two party well. I have attached the appropriate paper work for that approval. 12/30/2005 1 of 1 BLD2005-02134 MASON COUNTY DEPARTMENT OF HEALTH SERVICES _ Environmental Health —'�"� Personal Health PO BOX 1666 SHELTON,WA 98584 LOCAL(360)427-9670 BELFAIR(360)275-4467 Application for Determination of Adequacy FAX(360)427-7798 Instructions 400 , ... Flo Ufml tlndftapyttfotlsei�n citzd: 1 Submit completed ication,with attachments to the health 400ghumt for review. PART 1: Applicant/Parcel Identification Name of Applicant .�, 4L.✓ Date Mailing Address Telephone , Assessor's Parcel Number /•Z.ZIto 2 I — r")ny'?_O Type of Water System (Check One): Reason for Application (Check One): Public/community water system(2 or more connections) ❑ Building permit ❑ Individual well(one connection) ❑ Land use application,if so... ❑ Well ❑ Division of land ❑ Spring/surface water #of parcels? ❑ Other(explain) 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 2 Water Facility Inventory(WF1)Number: 141 e J� ❑ The water purveyor has filed a letter granting blanket hookups to this water system. ❑ I am the mans er of this water system. the water system has been approved for OZ services. There are presently connections m use. This will be the��connection. lTEs water system is able and willing to provi a water to this(these)connections wi ou'th t exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date Update:March 22,1999 i MR.F W*98M LIMA KP&PMM 10K1 KAM J S dME FOX ISLAM. WA 98333 2W-IM-828b Parcel # 12216-21-OOM L"d ; South 140 fast of Gov. Lot 1 5ectiafn 16, Towrdh4i 22 Worth RMP 1 W. of WM Ift Westemy of secondary State H" Wo. 14$. 3 l�ta.`dN i 3 �RTi•l PS�.Y __ __.._--. -S "` t N L-B. "} P�eRGs ._- --_ -- -•• _ f I