HomeMy WebLinkAboutWAT Application - 4/25/2001 04/23/2009 23:00 3602759617 EDWARD JRES 11949 PAGE 03
Ae/^.:/2009 23:59 3C0]]59G;] CtXlaan ]WLS 1190e AA[E 03
MA90N COVNTY
DEPARTMENT OF HEALTH SERVICES _ _ rorwa e.9ln
yn:romwApl Heorrh
TO DOX 1646 LOCAL
L (36 WA 9670
LOCAL(360)427-96'!a
BpLRADt(360)r5A461 A 4468
Application fot Determination of Adequacy
IYna4rucNaoa � C ty
3 ' 1
PART 1: APP11"nt/rar.d Idcntf5<stion
Nam.Of ADDlieaal . Date'_
Mailing Address��3y T I phmc
Assussarn Fain xamber �'�`/
c pJWafer CkmR On Rr orA iraliola etk e:
'ablfdCYamft Maur Syitem per mew &aiYmB Pr+�t
taAd.r.r.panui"I.de.
o Ndividral wear ao�rc.oecc.ewwaN.if m.. o Oirsiwi Wlae4
❑ Wea aofpucebt_
c Oda(e,pb;,) o annnday une adjmmtem
❑ Otan(eapbb)_-
PART 2: Water System Informartora
complete the SFcbon appropriate for the type of water systcnn being evaluated for adequacy:
ubfle Water S
Name of Water 6y.1,m -
Water Facility Inventory(WFI)Number.
The war==purvryw0sa fika a ktrcrprvnaM bla�ealmaN a.skwaM x Wem-
n Iwue Aaa (ta:.wuryrtnn. 'ne.rate garaa taw aMevee for�aml�Theman
wwarfm.mwe.]ba wilb.de naxmw wcnYmi•aSY a.a
vll�tle ucrw A•d((aaese)eomroni ed'rie the 5miu of Ne wato syumraary
am;n zerbv pne eed legal mtuln:en.
sisw a of Waver Sysaem Mraagar fat`
rr.IMARdY6MIr'61I/frALal.R WAn:Nw13LIM
Wi
g-d 66�2-6ZE-608 �ESdD a9elnn spue6 a;... e40r17 Go CZ 'Ju