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� <br />SNOHOhfISH HEALTH DISTRTCT <br />Envircnmental Health Division <br />�� Court House <br />Everett, Washington <br />DATE � / � / 7 C= �� <br />The undersigned owner does hereby wish to construct a building at <br />C �d /1/ �Q-G%� � i �-f'1 C 5 % <br />and agrees not to use the'sre facilities in this building until it is <br />connected to a public sewerage system. <br />In the event a public sewerage system is not avail2ble at t�e time I wish <br />to occupy this building, I do agree to mee� the St:ohamf.sh Health Dietricts <br />requirements for a sewage disposal system. <br />S igned __ /' /'� G`"".x. <br />.! <br />Address �09,�,,2. %�UGLys../ODl% vLV �!� <br />��OLG�'uJ0075 �L}G/F <br />Phone ���-L���-,s30� <br />Sewer Districl ��,c�i <br />111468 <br />� <br />