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ri SNOHOMISH <br /> HEALTH DISTRICT <br /> W W W.SNOHD.ORO Water and Sewer Adequacy/Food & Community Safety <br /> Facility name: [)MCA/i14,1 <br /> Site address:_ 9Q2 j. &ro t/091 Av.E • Uni fe. F-7- <br /> City: -EurvaAt State: Wks ZIP: (V zo <br /> Parcel number:_ Proposed number of seats: 0-0 <br /> Contact name:_ ljcmVt i2q yq L Phone: £Z(,-- 377- 34l/ <br /> Email: 1-4e,ticv iTv (p *too. Cory) Fax: <br /> New construction JJtemodel/Alteration 0 Expansion of existing restaurant <br /> Yes iNo Is the facility connected to a septic system? <br /> ''Yes 0 No Are public restrooms available? <br /> Ell-Yes ❑No Is a grease trap required by sewer district or building department? <br /> Describe the proposed project: <br /> Sewage system lErSewer bill or availability letter attached ❑ 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 /> Name of system: Sewer utility: <br /> The above system will provide service to the facility listed at the above address. <br /> System official: Phone: Date: <br /> Water system 13GWater bill or availability letter attached 0 Below 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: State ID number: <br /> The above facility ❑ is connected ❑ has applied <br /> The above system will provide service to the facility listed at the above address. <br /> System official: Phone: Date: <br /> Environmental Health Division <br /> 3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 ■ fax: 425.339.5254 ■ tel: 425.339.5250 <br />