HomeMy WebLinkAboutNOTICE TO FUTURE PROPERTY OWENERS OF PRIVATE TWO PARTY WATER SYSTEM - OTH Recorded Documents - 11/6/2023 NOV 08Zo?3
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2204227 MASON CO WA
Return To 11/06/2023 03:08 PM NOTCE
FRY #192377 Rec Fee: $204.50 Pages: 2
Jeff F'\-f 1 IIIIIII II IIIII IIII IIIIIII IIIIII IIII IIII IIIII IIIII IIIIIII III IIIII IIIII ll II
PO. 6o/. !S II
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11
NOV 06 2023
By - _
Grantor(s): (1) J cf(t;i y T 9 , (2)
Grantee(s): (1) PUBLIC 1 JJ
Legal Description (1) tot '�f SP -lb,c; eD) of 77 .3 S //!6 52C-•Ict r /z w
(Abbreviated form:i.e. lot, block, plat or section, township, range)
Assessor's Tax Parcel: (1) `1 ). l 1 9 - 3 - 9 o o 3 3
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:9
Tax Parcel: (Connection 1) Cl i 1 - 2- 3 - 0 o 3 3
Tax Parcel: (Connection 2) - - --
The system owner is responsible for keeping this system in compliance.
The name of the water system is: WE.L. 2P23 000 S5 Q Q4‘c
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 (half i not een granted one or more waivers from specific provisions of the
regulations.
Dated on this 6 G day of No ()cal , 20 2-3
I
Signature of Grantor(s):
(1) ) 46. 4 }_, , (2)
Page 1 of 2
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 (p}" day of 1N,VW' , 200 ,
personally appeared before me, who is known to be
signer of th above instrument, and acknowledged that he (she) (they) signed it.
GIVEN under my hand and official seal the day and year last above written.
001111).1#/pi,, ' "--A/14)..Qt Na p, bl P� tc
'S' •�� Notary Public in and for t'he State 61 Washington,
•0of .'' m,�:, residing at -►�1 V�V�.k
it it) NOT�►RY commission ('��j ZJO�-�
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r PUBLIC $';_
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Page 2 of 2
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TOPOGRAPHY PROFILE:
Direction: Scale: Approval: for office use
Building Permit number: Building:
Owner/Applicant: JCS( r'f'y Date of Planning:
J I application: Env. Health:
Parcel Number: 4 21 14 - Z3- 906 33