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HomeMy WebLinkAboutWAT2024-00001 - WAT Application - 2/14/2025 WAT 1, - 000 415 N.6*Sired MASON COUNTY Shelton,WA 99584 COMMUNITY SERVICES Shelron:360-427-9670,Eat 400 Bdfiaic 360-2754467,En 400 NW, c­mn H.a Elm.360-482.5269,Fat 400 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: Taylor Valverde Date: 02/13/2024 Mailing Address: 10501 108 AVE SW,Tacoma,WA%498 Phone: 7754202941 Parcel Number: 42332-50-00038 Division-block-lot: Division 11, Lot 38 TiWu UnhaNr Type of Water System Reason for Application ja Public/Community Water System(2 or more © Building permit connections) ❑ Division of land: ❑ Individual water source(one connection), #of Parcels? SPL ❑ Well ❑ Boundary line adjustment ❑ Spring/surface water ❑ Other(explain) ❑ ReplaOther cement ) ❑ 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 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: FEB 19 2025 Public Water System MASON COUNTY ENVIRONMENT Name of Water System: LAKE CUSHMAN SYSTEM 5 ET Water Facility Inventory(WFI)Number: 035290 (write'none°for two-party) ❑ I am the manager of this water system.The water system has been approved fond services. There are presently connection(s) in use. This will be the connection. d I am the manager of this system. This connection will be to upgrade or change the use of an existing connection on this system(i.e.: recreational to full time). Please indicate on the following line the nature of lhischange: going horn recreational use to full-8me once cabin is wmplefe 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 Ioc it regulation. Print Name of Water System Manager JESSE MATHEWS Phone 360-877-9668 Signature of Water System Manager, Date Date 02/14/2024 This form may be scanned and available for public view at www.co.mason.wa.us. J'9 H Fo m\ptl tng Water Revised 4IM021