HomeMy WebLinkAboutWAT2025-00187 - WAT Application - 7/25/2025 WAT 2025-00187
415 N.6th Street
MASON COUNTY
-� Shelton.WA 98584
`! COMMUNITY SERVICES Shelton:360-427-9670,Ext.400
..� , Belfair:360-275-4467,Ext.400
1/ Building,Planning Environmental Health,Community Health Elma:360-482-5269,Ext.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: Vlasak Homes LLC Date: July 25,2025
Mailing Address: 328 199th Ave Ct E Lake Tapps,WA 98391 Phone: 253-241-92185
Parcel Number: 32021-56-01036
Type of Water System Reason for Application
X Public/Community Water System (2 or more X Building permit
connections) 0 Division of land:
❑ Individual water source (one connection), # of Parcels? SPL
❑ Well 0 Boundary line adjustment
❑ Spring/surface water 0 Other(explain)
❑ Other(explain)
0 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.
EH APPROVED
Part 2: Water Connection Information Rhonda Thompson 09/22/2025
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System: Shorecrest Estates Water Company
Water Facility Inventory (WFI) Number: 78620-1 (write "none" for two-party)
X I am the manager of this water system. The water system has been approved for 680 services. There
are presently 628 connection(s) in use. This will be the 629 connection.
0 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
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 Kristie H chinson Phone (360)426-0773
Signature of Water System Manager Date July 25, 2025
This form may be scanned and available for public view at www.co.mason.wa.us.
J:\EH Forms\Drinking Water Revised 4/27/2021