HomeMy WebLinkAboutWAT2024-00261 - WAT Application - 5/16/2024 oo2.m(
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MASON COUNTY JUN20 Shelton,WA98584
COMMUNITY SERVICES Shelton:360-427-9670,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: Empire Home Construction, LLC Date: May 16,2024
Mailing Address: PO Box 241 Kelso,WA 98626 Phone: (360)43"716
Parcel Number: 32021-58-04062
Type of Water System Reason for Application
Public/Community Water System (2 or more IsdJ Building permit
connections) ❑ Division of land:
❑ Individual water source (one connection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement or Remodel(please indicate name
ff 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 APPROVED
Complete the section appropriate for the type of water connection being evaluated: JUL 15 2024
Public Water System MASON COUNTY ENVIRONMENTAL HEALTH
Name of Water system: Shorecrest Estates Water Company
Water Facility Inventory(WFI)Number: 76620-1 (write"none"for two-party)
® I am the manager of this water system. The water system has been approved for 660 services. There
are presently 614 connection(s) in use.This will be the 615 connection.
❑ I am the manager of this system.This connection will be to upgrade or change the use of an existing
connection on this system(Le.: 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 KrisI Hutchi on Phone (360)426-0773
Signature of Water System Manager Date May 16,2024
This form may be scanned and available for public view at vn w.co.mason.wa.us.
JdEH Foms\nnnking Water Iteviu 4/27/2021