HomeMy WebLinkAboutWAT Application - 10/8/1994 ��...,..w..'—.--.++-..,......��_.._..�._.: ....•. i........__ 1`411.01 1994 1!�ZPH FV2
POT OppICE Jim Inds
BHELTONI WA 08884
(200) 421-9070
AIIPLICA'i'ION pOR W."I'l:I/MINATION AIt1quACY PAX 427-SM
Pavlral 09/41ne
INSTRUCTIONS
I, Complete pert. 1. No dotorminatton ann he made uItL110lrt 1 kp , Ilv q�,lek ad.
), Complete cu1Y the portion oI Part 2 applyin9 to the of esker system utt l Led.
J. submit Pweplekad epplicetlen, with atbabasnU to tk tenith depnehmedk• for revkow.
PART I APPI,ICAVr/PAR(IEL IAENTIPICATION `
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NAILINO AbORESE
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5
AS86:89ORIS PARCEL NUMBER
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sUBDIVISIPN (It Applicable) 1 _ WT
TYPE PP WATER SYETEH -(Cheok One) AEASON Polk Aps OATIOlt ((-Chook One)
• Publ ke/cotamvnity Water, syekeld pull q 1'o961lt, Sinole Pamhy Ron
rU Tndivkdual system, Drlllod We11 Build or permit, commarol Al
U Individual Eyelom, Dug Well LI Build g pormlt, haplaca/Romodol
U Individual system, spring LdAd 49 A6 pleCatlgn
Individual system, 6urfsca Nster N
Ty
Individual system, Other L� Other
PART 2-AI PUDLIC WATER 8YSTIM .
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NAME PP Whikk SYSTEM WPI ID
oftr C rs -t-R�
no voter punaYp[ for this ryrt.e ha pd+l..urlY [Sled . unklllfred of x.ar .a.va.eY with in. h..Ikh
dbtrlet,
A..nsift of the ehev. ;u la[akead v,kap at%%,.. Th.weter system an Oph mobroe.l f..
gonna-tlona, vitA .(dI- e.rvlce
connacHon, pprmtly In uu. the aAplly hoe ,OproVal to oonnoct to thineut.r
system. IONIO. .l vAtif to the epplleset for daeutls pxlpetea 1 vomLtent wltn both the toter yet.
pion and Ra water ;lot romit srotontly in ,f[rel. vettr line, ate vollapl. to the Applicant'. pre set
11ny of its a Iio nL sae p y
PP a "do qtp(eetpry .;pppapa0l, LO D@' t lino,
tlSnnOTVpp or aYlrlq kapAelA t (/1.11' , /,f /� /' - D1Tt ;/}.'_/W