HomeMy WebLinkAboutWEL Letters / Memos - 6/22/2022 2183492 MASON CO WA
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Grantor(s): (1) 6C7 1 l4/
Grantee(s): (1) PUBLIC ��pp I
Legal Description (1) (/ 2/
(Abbreviated form: i.e. lot, block, plat or
section, township, range)
Assessor's Tax Parcel: (1) / 2 J 0 t] - 5 - U 0
NOTICE TO FUTURE PROPERTY OWNERS OF PRIVATE TWO-PARTY WATER SYSTEM
I (We)the undersigned grantor(s), certify that the water source located on the above-described
real estate under Legal Description (1) and Assessors Tax Parcel (1) situated in Mason
County, State of Washington, has been designated to serve a source of water to the following
parcels situated in Mason County, State of Washington; herein described:Tax Parcel: (Connection 1) l 1 O. - 7 5 - D 0
Tax Parcel: (Connection 2)
The system owner is responsible for keeping this system in compliance.Won
,
The name of the water system is: �3Q.«--S / 7cr) /5 We n
This system is designed to provide for two service connections. Planning and design approvals
must be obtained from the department prior to expanding beyond this number of services.
Additionally, a water right, obtained from the Department of Ecology, is required if the water
system exceeds exemption standards.
This system (has/has not) been granted one or more waivers from specific provisions of the
regulations. Z/26
Dated on this �� day of , 20 22.
Signature of Gragtor(s): .y
(1) , (2) •
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State of Washington
County of Mason
I, the undersigned, a Notary Public in and for the above named County and State, do hereby
certify that on this rZ a day of , 20 d
6.cy o d bR, `abkS personally appeared before me, who is known to be
signer of the above instrument, and acknowledged that he (she) (they) signed it.
GIVEN under my hand and official seal the day and year last above written.
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,,,,,,, AtPi-DO
ENE M Wfi�.,, Notary Public iin_and for the}Stat of Washington,
��Q yioi ' S 2o1� 14J 1,0T- `S te.,„.: '• residing at ,
��tyOTARy ���; ' My commission expires: `y/35/G25.
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21009497
s N: PUBLIC .
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