Lewis County Community Development
2025 NE Kresky Ave, Chehalis, WA 98532 ● Phone: (360) 740-1146 ● Fax: (360) 740-1245
W
ATER AVAILABILITY NOTIFICATION
Munic
ipal Public Water Supply
For Centralia, Chehalis, and Napavine Only
Associated Permits:
Site Address:
Applicant’s Information:
Name:
Mailing Address:
Type of development to be supplied by the Municipal Water System:
Single-family residential Multi-family residential Commercial Other (describe)
Number of connections necessary for proposal:
Note: Certification of water availability by a municipal water provider only indicates that water adequate for the above proposed
use is available on the date of certification. It is the responsibility of the developer to assure that all fees are paid and all other
requirements are met for connection to the water system. Neither the Municipal water purveyor nor the County can guarantee
future water connection until all fees are paid and all other requirements for connection are met.
Signature of Applicant: Date:
Note: A fee may be charged by the municipal water purveyor for review of this application.
Municipal Public Water Supply Availability (To be completed by a water purveyor.)
System Name: ID #
Membership/Account# Total WSDOH approved connections
Total number of connections currently being served
This system is capable of and will supply water to: (check one /fill in the blanks)
Tax Parcel # Lot(s) or Space(s) #
Short Plat # Lot(s) or Space(s) #
This property is located at the address listed at the top of this page and the proposed use is indicated.
On this date, municipal water, adequate for the proposed use indicated above, is available for the above project/use,
consistent with the systems approved water plan, per WAC 246-290 or WAC 246-291. Connection to the system requires
that all fees are paid and all other requirements shall be met by the applicant. Compliance and consistency with adopted
water plans, regulated by the state DOH, is the responsibility of the municipal water purveyor.
Certified by (Signature / Title):_________________________________________ Date: ____________
Address Phone Number
NOTE: Availability of water does not guarantee the granting of a building or sewage permit. Unsuitable soils or site
may
result in denial of sewage and/or building permits.
Permit Technician
:
WAN #:
click to sign
signature
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click to sign
signature
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