HomeMy WebLinkAboutBrickman_Utility Availability WATER AND SEWER AVAILABILITY REQUEST
Community and Economic Development
City of Arlington• 18204 591h Avenue NE•Arlington,WA 98223 • Phone(360)403-3551
Submittal Requirements:
1. Complete Application
2. 8-1/2"x 11"Site Plan/Sketch of the Proposal
Type of Request: Water Only ❑ Sewer Only ❑ Water and Sewer
Location/Legal Property Address: s \' Ayl\ Z
Lot#: Parcel ID No(s): Q Qq%U 00X 7(' Subdivision:
Project Scope of Work: IQ VI N t nE
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\(/,�- Office No.:
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Mailing Address: 1{DSNQX6 kt�U-2,Citr L29MState: A Zi :q ZD
Owners Agent: Office No.:
Email Address: Cell No.:
Mailing Address: City: State: Zip:
RESIDENTIAL INFORMATION
❑Proposed Single Family Residence xisting Single Family Residence XAccessory Dwelling Unit
❑Proposed Multi-Family Residence:#of Um s #of Buildings ❑Residential Plat: #of Lots
17777 1 COMMERCIAL INFORMATION
❑Binding Site Plan/Plat:#of Lots #of Phases #of Buildings Total Square Footage
TYPE OF COMMERCIAL USE
❑Hotel/Motel ❑Food Service ❑Medical/Dental ❑Office ❑Retail
❑Vehicle Service ❑Warehouse/Storage ❑Industrial ❑Other(specify):
Commercial Water Usage:Monthly Estimation: Gallons
WATER,SEPTIC SYSTEM AND FIRE
Is there an existing Well on the property? Afr-_�,
es ❑No Is there an existing Septic System on-site? Yes ❑No
Water Meter Size Requested? /8" ❑ 1" ❑1.5" ❑2" ❑3" ❑4" ❑6"
Type of Fire Protection Requested? ❑Fire Sprinkler System ❑Fire Hydrant ❑Unknown
I,the undersigned,request City of Arlington Utilities Division to certify willingness to provide water and/or sewer as indicated.
The above information is complete and accurate to the best of my knowledge. I understand that any changes to the above
informatio must be reported immediately to the City ofArlington Utilities Division as a condition of Utility Availability approval.
Sig n a tu reTjbWer/agent) Print Name Date
Page 1 of 2 REV02.2022
TO BE COMPLETED BY THE CITY OF ARLINGTON
CITY OF ARLINGTON UTILITIES DIVISION - PRELIMINARY INFORMATION / CERTIFICATION
A water main or other capital facility improvement: ❑is required; ❑ is not required.
(If required,refer to below conditions).
Water is presently available from the City of Arlington to service the above referenced
property and specified number of connections upon payment of applicable connection fees and charges.
Fire Flow Estimation: Static Pressure Residual Pressure Flow gpm
A sanitary sewer main or other capital facility improvement: ❑is required; ❑ is not required.
(If required,refer to below conditions).
Sanitary sewer is presently available from the City of Arlington to service the above referenced property
and specified number of connections upon payment of applicable connection fees and charges.
Approved By: Date:
EXPIRES 18 MONTHS FROM DATE OF ISSUANCE
Additional Comments/Conditions: