HomeMy WebLinkAboutBLD2022-00540 - BLD Water Adequacy - 4/28/2022 N�� WAI -
:. MASON COUNTY .m '
zL COMMUNITY SERVICES •
_ 1yy' Building,Planning,Environmental Health,Community Health
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415 N 6th Street, Bldg 8, Shelton WA 98584,
Shelton: (360)427-9670 ext 400 ❖ Belfair: (360)275-4467 ext 400 Elma: (360)482-5269 ext 400- �`�
_...I FAX(360)427-7787 I V E V
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Application for Determination of Water Adequacy
z APR 2 8 2022
w 2, Instructions 1 S W. Alder street
1— 1. Complete Part 1. No determination can be made until Part 1 is fully completed.
z7 Q 2. Complete only the portion of Part 2 applying to the type of water connection utilized.
CD w 3. Submit completed application, with any required attachments for review.
_ = 4. An approved building site plan must accompany this application.
Z Part 1: Applicant/ Parcel Identification
W � / /
Name on Applicant: Ch.( .t 1. Ha,Ha, ��r � �;��,��, Date: 3 1 � 0 02;`
Mailing Address: c›2c+7 I\/ US IL,, p I Phone: a 5-3 - o?� ' �/ 7�;
Parcel Number: Li 5 9
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more IBuilding permit3l 12.022 —005&4D
connections) 0 Division of land:
0/Individual water source (one connection), #of Parcels? SPL
L3 w Well 0 Boundary line adjustment
0 Spring/surface water
0 Other(explain) 0 Other(explain)
0 Replacement or Remodel (please indicate name
If you have more than one residence connected of water system below if applicable—no
to this well, check the Public/Community Water signature required)
System box.
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System: 1L"( CO .lam],L -, Ifyl041) ,,Q , LUG-41A—
Water Facility Inventory(WFI) Number:
(write"none"for two-party)
❑ I am the manager of this water system. The water system has been approved for services.
There are presently connection(s) in use. This will be the connection.
❑ I am the manager of this system. This connection will be to upgrade or change the use of an existing
connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature
of this change:
This water system is able and willing to provide water to this (these) connection(s)without exceeding
the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager Date
This form may be scanned and available for public view at www.co.mason.wa.us.
J:\EH Forms\Drinking Water Revised 1/25/2018
5 �
Potlatch Beach Mutual Water Company
PO BOX 987
Hoodsport,WA 98548
April 27,2022 .
To: Heidi Aikens, haikensellexarhomes.corn
C:(360)302-6275 I 0:(360)379-86001 F:(360)379-4171
92 Kala Square PI,Port Townsend WA 98368
9224 Ridgetop Blvd NW#101,Silverdale WA 98383 •
RE: Assessor Parcel to 42223.60-00099-100
Owner: Christopher T&Crystal L Harrison
System Operator: Potlatch Beach Mutual Water Company(PBMWC)
Mason County,WA
Meter numbers: 76169418(Lot 99)
44354028(Lot 100)
Property address:22040 N HWY 101,Shelton,WA 98584
Water meters have been installed in accordance with County plans and specs.at this location by the Potlatch Beach
Mutual Water Company(PBMWC).
PBNWC will provide domestic water service to this property according to our by-laws.
Cody Morris,Treasurer,PBMWC
•
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