HomeMy WebLinkAbout20260812_PWD4211_App WATER AND SEWER AVAILABILITY REQUEST
Community and Economic Development
City of Arlington• 18204 59th 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: 1 S �i' 10 1 q9a
Lot#: _ Parcel ID NOW: _'5/v6agr tv 2 zn,,!�d'c' Subdivision: ti!
Project Scope of Work:
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Owner Name: ftl Office No.: 2_51 -
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Email Address: Cell No.: _ -
Mailin Address: 2& = In, 57 E City: A4 e State: 1Aj A Zi Z7(
Owners Agent: for.+, Office No.:
Email Address: Cell No.:
Mailing Address: City: State: Zi
RESIDENTIAL INFORMATION
❑Proposed Single Family Residence ❑Existing Single Family Residence ❑Accessory Dwelling Unit
❑Proposed Multi-Family Residence:#of Units #of Buildings ❑Residential Plat:#of Lots
COMY4MCIAL IrAiiPdRNATtON
Binding Site Plan/Plat:#of Lots #of Phases #of Buildings 2_ "Total Square Footage L?
TM Or CONKOKI#11b USE
❑Hotel/Motel Food Service ❑Medical/Dental ]Office ❑Retail
❑Vehicle Service ❑Warehouse/Storage ❑Industrial ❑Other(specify):
Commercial Water Usage:Monthly Estimation: 2 S c- —v Gallons
WATER,SEPTIC SYSTEM AND FIRE
Is there an existing Well on the property? ❑Yes E]No Is there an existing Septic System on-site? ❑Yes ENo
Water Meter Size Requested? ❑5/8" ❑ 1" ❑ 1.5" DR 2" ❑3" N4" ❑6"
Type of Fire Protection Requested? "Fire Sprinkler System ❑Fire Hydrant N Unknown
1,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. 1 understand that any changes to the above
information must be reported immediately to the City of Arlington Utilities Division as a condition of Utility Availability approval.
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signature(owne/agent) Print Name Dale
Pagel 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: