HomeMy WebLinkAboutWAT2023-00083 - WAT Application - 4/25/2023 RECEIVED
APR 25 2023
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615 W. Alder Street
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415 N.6t Street
/" j MASON COUNTY Shelton,WA 98584
COMMUNITY SERVICES Shelton:360-427-9670,Ext.400
f J Belfair:360-275-4467,Ext.400
Bu ld•ng PLinning,Erwiron nentaf Health,Community Health Elma:360-482-5269,Ext.400
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Application for Determination of Water Adequacy
instructions
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: Alexandra Garland Date: June 6, 2022
Mailing Address: PO Box 2088 Shelton, WA 98584 Phone: (206) 459-1021
Parcel Number: 32021-58-04063
Type of Water System Reason for Application X Public/Community Water System (2 or more X Building permit le l ZV3 o — co 454
connections) 0 Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well 0 Boundary line adjustment
❑ 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. /� P
Part 2: Water Connection Information /`-{ R VE D
Complete the section appropriate for the type of water connection being evaluate MAY 0 9 2023
`MASON COUNTY ENVIRONMENTAL H
Public Water System EALTN
RET
Name of Water System: Shorecrest Estates Water Company
Water Facility Inventory(WFI) Number: 78620-1 (write"none"for two-party)
XI am the manager of this water system. The water system has been approved for 680 services. There
are presently 588 connections)in use. This will be the 589 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.
Print Name of Water System Manager Knstie Hutchinson Phone (360)426-0773
Signature of Water System Manager Date June 6. 2022
This form may be scanned and available for public view at www.co.mason.wa.us.
J:'.EH Forms.Drinking Water Revised 421.2021