HomeMy WebLinkAboutWater Right Claim - PLN General - 7/31/1979 d Sl-�atc of
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ater Right Claims Registration
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fight Claim =z
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Name �.✓H J / i = �i i !,: f--- — -
--� (Short Form)
Address > 'r L ') C., a t iC, y
i2'9 ` ZipCode
-- --- Phone No.C t S .a (e q G
1) Source from which the right to take and make use of water is claimed: [] Surface Water ,:E] Ground Water
If surface water, please indicate source;give name if known:
(River,stream,lake,pond,spring,etc.)
2) Purpose(s) for which water is used:
El Domestic ❑ Stockwatering Irrigation (lawn and a g rden) ❑ Other Use (specify)
3) Legal description of lands on which water is used' portion of the NJ NWT NE4 Section 20s Z`wp 23 No
Rge 1 W lying West of tt:e Old Statc fiiway, description as follows; commencing at the
Y'orthWest corner of M'L h*E run thence S 88°52'2.3 jS along the North Boundary U .58_F;
a t-.
Y
,r
s Qf y—S Cl1sI .,tate Hitmv thenc Uong—
s,=.id r6ght of way N 6017' E 100.91' ;thence N 890 03'18" W 257.91' to the 15rtte P.0.8.
If located within the limits of a recorded platted property:
Lot_ Block _of
lease indicate Sec. U (Give name of
In addition plat or addition)
p T.,-• :S N-,g,_ W E/W"W.M.
r= County in which lands are located
DO NOT USE THIS SPACE I hereby swear that the above information is trite and accurate
The filing`of a statement of claim does not constitute an adjudica- to the best of my knowledge tj belief.
tion of any claim to the right to use of waters as between the water X "
use claimant and the state or as between one or more use claimants
and another or others. Thi�,'acknowledgment constitutes receipt for
the filing fee. Date
Date returned This has been assigned If claim filed by designated representative print or type full'r Water Right Claim Registry No. name and m�ilitta address of agent below.. o
• Director,Department of Ecology Additional information relating to water quality and/or,
well construction is available.
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Return all three copies with carbons intact, along with your fee to:
Y.
Department of I-:cology. Water Right Claims Registration, olvmpia. Washington 98504 ��