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Snohomish H�alth District vo � <br /> Environmental Hsalth Division /ID. � <br /> 3020 Rucker Ave. - Sufte 102, Everetl, WA 98201 �� <br /> (206)339•5270 <br /> Request For Report On An Onsits Sewage Disposal System <br /> O Check box N applicatbn includes Water Report Request and attach cor.ipleted appl�atfon. <br /> RopenyT�ca�000�rix ry�g-000-Du�/-GDa/ <br /> Ropay�: �0� R�FIb,� .,.� cy F_✓���fF- <br /> SEND REPORT TO: (PrIM lull name, address and zip code, use ballpoint) �� ��� <br /> �-I orin E I I edne TOTAL 90.00 <br /> �D6 RcacVr�rca �.nrw. ClK � t0.00 <br /> C✓�rp t��.�a. �47.0� CIIANBE 0.00 <br /> �egal DE,'soAPfon. Sec�'�TwP�_�l�l p� , � � •� a �J.� iJU/✓ .�Q. <br /> /+�ptartsNare - - aPMve ��9- 1335�� " � i2,se <br /> a�resr�eL� g-Glnr'�n _ �I,�.�ne. Y/ r�nre �5��[.,532_ <br /> Is nouse om�iecrt (Yes�rlo� \I es M ro►,date vac�ed <br /> vearrn�aeti,t 19�e0 r�,n�erabecloon� 3 <br /> DatesEp6ctaik�strximedUflKw�un� Rirpedty IlnK�/ot�n <br /> i-Iasthese�i��lemtatedamalurriior�ed7 (Yes�{a,F h� �� ,�r �, n , nrnhlpm� PUr�. <br /> �-. �'� /�'d �11w onrptt (nH tLw <br /> ' � <br /> Has the septic system been repated or aAered7 (Yes� Desa6e � <br /> '(�'�i r_l.�la nat �,incr �.iP. rh,r�l�r+ nrw�rfii, 148'I. <br /> Snce new,has thB home hed arry eddtbrS? ('f�RJo) Desd6B Nf�NE '�'�tn�' we k nnur al-. <br /> A�artS'�i�aaie�le2ta�c�/���w [kla 5�%1�92 . <br /> �\ / (FOR HEA TH DISTRICI' USE — BALLPOINT ONLV) <br /> rtq�ec�on Dase',J�,�Pibr kspeqion O�e(s) � <br /> t� Sewage disposal system appears to be luncdoning at time of inspedbn. 0 As•Bulfl on file. <br /> 2)0 Sewage disposal system malfunctioning at lime ol inspecllon (owner to be noHlied o1 requlred repairs). <br /> )❑ Home vacant at time of inspection, system not in eperation. <br /> 4 lieallh Dislrict records indicate that Ihe seotic tank has nol been pumped within the last 2 1/2 • 3 ye�rs. <br /> Jr,/�� Heal�h District record; indicate previous failures on ad;3cent lots. <br /> 1(�IyL 61 O There appears to be a ponbn(�prox. teet)o�drairiield bcated urx�er: <br /> t <br /> Ccrrrre� <br /> ScJixl_ � ? �e � / !� <br /> nwronmenlal Hej}Ilh D`iV.is' n <br /> / � /�'/�l /'��1�(/j��.i <br /> / „ . <br />