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HomeMy WebLinkAboutWAT2026-00074 - WAT Application - 3/30/2026 MAR 3 006 _-� • flCiVE • • • Mm)VN',,C1DcU 79 6 WA.98584' ay j _ a icSi.,iCe.�• :_ Stieltott:360=427�9670;.Ext.AW " t� �l ! , irir>ill iFv ...-... . App l c t on for Deter iflatfior th Water Adequacy 4. .. .+ a'd'°�°'.?`.. .�1::,7:)ta•'�•':1;� } i.`�:�,;St�i:.�:•!Z {•`!! ;i;'-°'` �k:����t; �:i f Instruoticans ........ .,_�...�.....� .._._.._-- - :. : 1, Complete Pert•I No de46rr tnatlon�can be made until Part`1 i ul 'co let®�dz, 2. s orrr lefa only the"p�brSlori f'4t a l�lrtç toihepe of vo ter°obi iil,.rtifi `s� lExerl: "i; :.c �9§r d sgtaoh�arsnt .:> :.sine fr led-bYtit i s9do ' arY ::t tte'a G cat n:�-::r:yr•, tct:.=:u : . /.::':::.. ,:,r�= 4 i•`,r ;'K:i :s.F:...'+ :#7t: >•e,;'..h.,r^:'3's ic-,rw43: ''lv�;::{i `�; !iC)rn at�I, y-e",,.�1tk7:C.L,r..• s rr'T-1-'S?p:� • yc Part 1: A►pplicanti Parcel identification• Name of:Appllcant: �._.. P,, �E! ! pate:.• r 16 Z n • Parcel Number: G`'''.�` [] w-0k( ,`C3' '{ :3.` " lv.1.s cSn 1 Lot 160 • ___ Type of Water System • •. •. Reason or)Aloplyc tiar Public/0ommunity Water System(2 or more • Su)iding permit i' 1d • � tP m.66 6 O13)a) t•L1 [IV-dor.c h i : is IndMvtduai.water source(ot�eormeotton) .. ......_.._,._.�_.__._.-__ ._#of Parcels? ____.. _,._..SPL Y�Yeilii[#';� °::r`'ti��:�`;1 a)?'�:`_...:'� :., �.5"_�lr�!f"l .... 1_::::: s IJ 'Soiinctafy line a ustm �it ❑ 'bprit?gls trfaee<water-, �+ rzs` :,�iw=:' . . t . 1. �' �4 1 • J Other(explain) .. ,. ....: -,.< .: �. ❑`y`t�f�ier'(� tam)' 0 Replacement-or Remodel(please indicate name • if yoi ? we m a.,"w Man i.j.w rt�a k or.a GLRr'Ynsu d • brr w�e+r oyztr :3e-lw if ap?iab;b • to V3its w ,-Mos.�k'4��a l jjy•W i . • ear s I tiirady , System.boa": .. .. ... ' :d5,.r - , •. . . , .,".. , m ^- » . _• ,• • ______.• •y�,.��n.__ Part 2: Water Connection lnf®rrri; tOn • F" 'PROVEI Rhonda TCiompson64I23/2O26 CarrEpiets th nmx:c!e ipropdats fcr the typa"of'awater connection bei.n -o-eatuatod: • - ,�.. _.. ..�,_.,_ ._ Name of Water System ��;4K1*•"i✓C7�T-�I�AN...SY�i'ElCtl__5.......,��.�._.:�ti.,_...._^..�, .._.. M _m.... . __ _. Water,Facility Inventory(W i X0.,35290 , � s ) • F)NordIIer: y=• '' (wrlta 'bons for two part i bs or S itFb�Y?� i1" :''e r wrrr " , •`? .9t3Y 's,.Tka.`l are presentiy connection(s)in use. hts will be the " coririection.- "; #eut '> •(l • 1 am the manager of this system.This connection will be to upgra de"3air:tli altga`Yhe`itsa'o art'a Cisting cc. oYyt (ss. sf m i:e�;regreatianal,fo..f1u,Il ti"me Pleas( �ndicrpfteon(`he:folln In ne:y`he nature of 17�`a �a ,V..� fl 1 n e: Robert"l_. Blair. `: :.... , r ! this 4h�1, RobvitL.6 briar " . . " � � BahaR L.Dlair(Mar90,202814.3 AU CDT: • T •ter≥rynt'ern!s Ub! .aid wi!t'rtj to:mcy?4le watsr-to this('ihs�s) ct}ct9(s)wlthhut excm<'cd ii9 t_ •ilan(te ofi tfcc afar nystei or aruy iI Its � $t�a are"-. Y' ►I i str; • : :"•vIYiY;fUds.:5:3"iu? .ti 1>` :" Print Name of Water System_IUCnagpr JESSE MATHEWS _ M Phone 360-877�9�6 —Signature of Water Systern•Manager ._.._..-....,_Date 03/31/2026 ._ _.__....... : ti f© fi e �Y__G�r�a c (� J:\EH Forms\Drinking'Water • c.. 'Revised OSl08/207�t • Page 1'pf