HomeMy WebLinkAboutWAT2022-00125 - WAT Application - 6/22/2022 - d2ozz- ooc2z
WAT202Z - 00Ia5
( 'ry ✓ \ MASON COUNTY
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,�J b , COMMUNITY SERVICES
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Building,Planning,Environmental Health,Community Health
S 415 N 6th Street,Bldg 8,Shelton WA 98584, I V C V
Shelton:(360)427-9670 ext 400 .C.. Belfair:(360)275-4467 ext 400 Elma:(360)482- 2
FAX(360)427-7787
Application for Determination of Water Adequacy JUN 2 2 2022
Instructions 615 W. Alder Street
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water connection utilized.
3. Submit completed application,with any required attachments for review.
4. An approved building site plan must accompany this application.
Part 1: Applicant( Parcel identification
Name on Applicant: Solid Homes Pcft . 1.V' Date:
Mailing Address: PO Box 130 I Phone: 253 5909481
Parcel Number: 321275300181
Type of Water System Reason for Application
CI Public/Community Water System(2 or more ,2r.Building permit 12022.00CP 2-
connections) 0 Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well 0 Boundary line adjustment
❑ Spring/surface water 0 Other(explain)
❑ 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 APPROVED
Complete the section appropriate for the type of water connection being evaluated: JUN 2 7 2022
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Public Water System ENVIRDENtR�
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Name of Water System: I LJ t! ((i�( (_.�--
wsoN coup � �
Water Facility Inventory(WFl)Number. '-144(5O
(write"none"for two-party)
XI am the manager of this water system.The water system has been approved for 1337 services.
There ere presently I 25‘ connection(s)in use.This will be the t24-7 connection.
0 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 1. U,tU't Date '20—zoZ 2.
Thisform may be scanned and available for public view at www.co.mason.wa.us.
J:`,EH Forms',Drinking Water Revised 1/25/2018