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HomeMy WebLinkAboutCOM Water Adequacy - 4/14/2020 RECEIVED (© 10713 -noou3 APR 14 2020 � ,��� 615 W• Aloer Street Public IJ6Wth 9'3 aMeYsi4kJr*f6asarer.. h®hhi'M nLWnty PO Box�£firilteY (350) 2 70 18BO8415N6."' theat, Bit.WA 98584S0Le$zhf400 h Elma:(380)482-5M,,d 4M -- - - FAX MO)427-7787 Application for Determination of Adequacy Instructions lefe 2tf. s` o p D-,'93e'da�u aid s -�'r"llC4R R Dart 1 "`t[HMmmolefeif £on!P.(ate'onjy+l4eyo o oa..r 'a�PIyIn9So'thesiype •yfafe� ,yfh�zr�'" 3 Q uGniC`m`m'leteda hcatop':wiOraNacbmenfs.tathe]iealhd enlNNER,.ew Part 1: Applicant/Parcel Identification Name on Appfcant First Oly3noic Holdings,LLC Date: Augost 22,2013 Mailing Address: FO Box 997,Gf2Harbor WA 98335 Phone: 253A57.5580 Parcel Number.: 12329-42-00190 Type of Water System - Reason for Application LPubiic(Community Water System(2 or more C}"Buildng permit connections)- El individual water source(one connecti n), ❑ Division of land: ❑ Well #of Parcels?_ SPL ❑ Spfinglsurfacewater ElBoundary line adjustment ❑ Other(explain) ❑ Other("plain) if you have more than one I]testdertrx connected Replacement(please Indoate name of water to this well, check the Public/Community Water system below 0 applicable—no signature System box. required) Part 2: Water System Information - /{c t.ryi. ft Complete the section appmpdate for the type of water system being evaluated: Public Water S stem != ' "� of Water System: ,.� W ✓ir 4, / Water FaWity.Inventory(WFI)Number.1. 2S(D (wore°none'for two-party) J4) [Nam � I am the manager of this water system The water system has been r There are Presently-1xl 6 connecgon(s)in use.This will be the� c,nrnsb.R I am the manager of this system.This connection unit be to upgrade or change the use of en existing connection on this ystem ii.e.:recreational to hdl time).Please indicate on the following fine the nature ofthis change: ��> yr f b�-f `/ aa-e This water system is able and willing to provide water to M(these)connections)without exceeding the limits of the water system or any limits set by an oval regulation. Signature of Water System Manager Date 2-7 /,j Revised 7=3 This form may be scanned and available for public view on the Mason County Web site. Pe tof2