HomeMy WebLinkAboutWAT2024-00350 - WAT Application - 11/15/2024 WAT 2D2
415
Shelton.W A 9858
70
MASONCOUNTY Beltak 3fi0.75-0467 Ex 40a
Public Health &
r Determination of Water Adequacy
Application fo
leted.
be made until Part 1 is full com blized.
of water connection u
1, No determination can to the type {or review.
Instruction late pan portion m Part 2 applying chmen>s
1. Comp the po required atti lication.
Complete only fcation with any req an this a
2. Submit completed aDV Ian must accom
3. Ana roved buildin site
4. 10/1012024
Part 1: APPlicanU D
Parcel Identification its: 360 8980055
Applicant, AB Fine Homes LLCWA985g2phone.
Name on APP E3204!5(3P:G:1:)0:9�'
ECH D
Mailing Address: for Application _
Reason ' I pl2.a�
Parcel Number: , Building permit -)�>16 2.02`T
Type of Water System
Stem(2 or more ❑ Division of land. SPL-
sl publiclCommunitY Water Sy #of parcels?
connections) BfGa(one connection).
❑ Boundary line adjustment
❑ Individual water so ❑ Other(explain)_ndicate name
17 Well water ❑ Replacement or Remo
rfeapplicable-no
❑ Springlsurtoce of water system bell'
ex lain)- signature required)APPROVED
❑ Other(explain)
P residence connected
than one unity Water
to this have more than
the Public/Comm NOV 15 202li
System box.hec
ation evawated: MASON COUNP ENVIRONMENTAL HEf
Water Connection Inform RET
Part 2' ropriate For the type°f`"later con^action being
Complete the section apP
Public Water System
of Water System: AldeNrook
write"none"for two-Party)
Name PI)Number: 01050 8 services.There
roved forWater Facility Inventory (Y'1 hasthbeen 540 P connection.
! stern.The water systemexisting
t ® 1 am the manager of this we cormection(s)in use, will be rade or change the use oS an
n will be to uPg Indicate on the toll
am line me nature of
are Presently 5� This connection please
er of this system, edin9 the
Jam the manager (I recreational to hell time without exce
❑ ep on this systemthese)wnnec6°^(s)
connection rovide water to this(regulation
this change: state and local ro9 360.877.5249
This Water system is able and willing LO p phone -
� stem or any limits set by
Ilmits of the water system Milro 1011112024
Manager Brand Date
Water System G r
Print Name of W ncounb ra. ov
Signature of Nafar System Manager - F.ga t
and avnllable for Public view at
w,�'maso
may be scanned xevised04lIV2024
Ibis to
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