HomeMy WebLinkAboutWAT2024-00319 - WAT Application - 9/10/2024 WAT
MASON COUNTYD
Public Health & Human Services Shelton. e,
Belfar..360-2754467,Ext.400
SEP 10 2024
Application for Determination of Water Adequill W Air Street
Instructions
1. Complete Part 1. No datermmation can be made until Part 1 is fully Wmoleted.
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 Ian must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant: AB Fine Homes LLC Date: 8/28/2024
Mailing Address: 871 E.BEACH DR.Union,WA 98592 Phone: 360 898 0055 eat 3
Parcel Number: 3210430-00089
Type of Water System Reason for Application
LJ Public/Community Water System(2 or more F Building permit
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water ex Other❑
❑ Other(explain) (explain)
❑ Replacement or Remodel(please indicate name
If you have more than one residence connected of water system below if applicable—no
to this well, check the PublicJCommunity Water signature rer`'11 gt 19P R 0
System box. II'"' \/�D
Part2: Water Connection Information p�� OCT 08 2024
Complete the section appropriate for the type of water connection being evalustW COUNTY ENARONMENTAL HEALTH
Public Water System RET
Name of Water System: Alderbrook
Water Facility Inventory(WFI)Number: 01050B (write"none'for two-party)
® I am the manager of this water system.The water system has been approved for 636 services.There
are presently 537 connections) in use.This will be the 538 connection.
❑ 1 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 Brandy Milroy Phone 360-877-5249
Signature of Water System Manager \:� ,p..(� Qa� Data 08/30/2024
This form may be scanned and available for public view at www.masancountvwa.aov
\EH Fo=\nei ng Water Rl�ieedW17i2024 Page 1 of2