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4/6,1e/4,,,,11 n,o a.,•, a/I tl'!tsas1il <br /> SHORT SUBDIVISION APPLICATION <br /> Snohomish County Office of Community beveloprtIent Page l <br /> Snohomish County Administration Building FILE NUMBER <br /> Everett, Washington 98201 <br /> Phone 454931 Rf ij9 ss:'.i Sffu9RT PLAT' tufts'ft A.t'. 9tf. R&uat fat,"t7 <br /> None (Worn./ <br /> Y', <br /> Y 'i,?1:'. C 1131 a!n;' PMN:: Ierra.l <br /> NAM_: <br /> Ipawn, firm or oogsoralion owning the property/ <br /> ADDRESS: Mini Montana Road; Everett,WA 98:((ira <br /> CONTACT PERSON OR AGENT REPRESENTINGWendel I .Intinrion _ PMN' 435, .v.IL <br /> AOORESS._ P.O. Roue 'I:'6; lrlfngt rn, WA 9R:,!23 <br /> SEC: • iii7P. 2g RNG: 4 ZONING Of PROFERTY Rit ofwoo <br /> SOURCE OF WATER SUPPLY ?fuktLteo Water District <br /> NAME OF WATER DISTRICT, IF ANY Same _. <br /> NAME OF SEWER DISTRICT, IF ANY . , <br /> • METHOD OF SEWAGE DISPOSAL. _____ _a_._ _..� <br /> NOTE: This review applies only to the short plat as a whole. Snohr' h Health District signature does <br /> not indicate suitability of these lots for on-site sewage di-'i . zvtems. The ort'ssile sewage i <br /> disposal requirements for each lot shall be subject to soil at-- 1.O.s as determined by tests pew' <br /> formed on individual lots. ! <br /> DATE PROPERTY ACQUIRED; .VA/19.`7 <br /> TO BE SIGNED BY THE APPLICANT: 1 <br /> I hereby certify that the legal description of the land being divided and accompanying this application <br /> shows the entire contiguous land in which there 2 an,interest by reason of ownorshis,SIMIStlfgragshte. <br /> earnest money agreement, or option by any person, firm, or corporation in any manner connected with the <br /> development, and listed below are the names, addresses and telephone numbers of all such persons, firms <br /> or corporations. (If same as applicant named above, leave blank.) <br /> I. IVAME -- Ptwne„ - <br /> ADDRESS __ �..__._ <br /> 2. NAME_ Phone" _ <br /> ADDRESS _ �._ <br /> ` r <br /> (Sigrnatune of ADO nntl <br /> `; VICINITY MAP l <br /> (Please provide sufficient detail to allow field inspector to locate site/ i <br /> i. <br /> i. <br /> . <br /> _ <br /> 7 -_. ......n...r,..__....-._.... .. <br /> 9 41 n2901 54 // <br /> *It 1869??A 1000 3 9 <br />