HomeMy WebLinkAboutWAT2023-00186 - WAT Application - 7/25/2023 •
WA'I' g - 00/B 6)
MASON COUNTY
( ) COMMUNITY SERVICES
\ Building,Planning,Environmental Health,Community Health
415 N 6th Street, Bldg 8, Shelton WA 98584, 1 V
Shelton: (360)427-9670 ext 400 Belfair: (360)275-4467 ext 400 Elma: (360)482292E 46E1i L—
FAX(360)427-7787
Application for Determination of Water Adequacy JUL 2 5 2023
Instructions 1 5 \N. 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. 1�
4. An approved building site plan must accompany this application. ENVI RON M NTAL
Part 1: Applicant! Parcel Identification HEALTH
Name on Applicant: AB Fine Homes Date:
Mailing Address: 871 E Beach Dr Union,WA 98592 Phone: 360-898-0055 opt 3
Parcel Number: 32109-50-00099
Type of Water System Reason for Application //^�,yyam�
O Public/Community Water System (2 or more Building permit �...Q p'a jQLD3-da
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
Complete the section appropriate for the type of water connection being evaluated\ P P R O\/E D
Public Water System v
SEP 19 2023
Name of Water System: Alderbrook 4ASON COUNTY ENVIRONMENTAL HEATH
Water Facility Inventory (WFI) Number: 01050 B RET
(write"none"for two-party)
CI I am the manager of this water system. The water system has been approved for 636 services.
There are presently 522 connection(s) in use. This will be the 523 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.
u:o Date 05/23/2023
Signature of Water System Manager �,t?�,.,s��( / �ti> ,� f'
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