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14 SNOHO iSH' <br /> HEALTH ATH DISTRICT�4ffi-;:e- www,sN©HD.oRG Water and Sewer Adequacy/Food.& Community Safety <br /> Facility name: t ,nJO 6 c.,-16.. Cit.)•,:::- <br /> Site address: is L <br /> tiLy <br /> City: State:141/ ZIP: <br /> Parcel number: ??0.5/800' ifi 't roposed number of seats: t 7 <br /> --" <br /> Contact.name: . FSC (zs i1-- ! o rti., r f iv e- Phone: , i�S_CCn ,` ,2- `C <br /> Email Yt7C5'c�v 0- C/ dr';CG'1'"Fax l <br /> ❑.New co struction emodel/Alteration 0 Expansion of existing restaurant <br /> es No Is the facility connected to a septic system? a 26 1 sy, . <br /> L Yes ❑No Are public restrooms available? <br /> Yes ErNo Is a grease trap required by sewer district or building.department? <br /> Describe the proposed project: L.3I LAS t.3 i f);:rz (-FA/1.-171 I Ai CcieZae'N7 f t )` C <br /> Sewage system 0 Sewer bill or availability letter attached Er Below completed by official <br /> This section should be completed by a Public Sewer System Official, if a sewer bill or availability letter is not <br /> provided. <br /> r <br /> Name of system: t 'r � f� "1 w <br /> Li <br /> Sewer utility: � � ,� <br /> The above system witiproviide service to th- facility listed at the above address. <br /> T <br /> System official: ., jl: 4 L. s'' i K Phone: 5 XI Date: -5-1 ,/ <br /> Water system 0 Water bill or availability letter attached lailelow completed by official <br /> This section should be completed by a Public Water System Official,if a water bill or availability letter is not <br /> provided, <br /> Name of system: {t # State ID number: <br /> The above facility ` is connected 0 has applied <br /> The above system wi pr+vide service the acility listed at the above address. <br /> System official,. i 7 ice Phone: ' /-.. 2V—ogyO Date:.4S-1///;°,11 <br /> S,1a',dE.ta3srrnei tP,an ev`'{tUa.neQ<,5t .3 ,?-) 'z <br /> Environmental Health Division <br /> 3020 Rucker Avenue,Suite 104 a Everett,WA 98201-3900 a fax:425.339.5254 R tel:425.339.5250 <br />