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� _.., SNOHOMISH <br /> HEALTH DISTRICT <br /> W WVJ.SNOHD.ORG Fnvironmental Health Division <br /> PERMIT TO INSTALL AN ONSITE SEWAGE DISPOSAI SYSTEM <br /> This Snohomish Health Distnct Pcrmit ro mslall an onsde ,ewage disposal system is vaiid cNy when iswed cocwrrently w�th the cdy or <br /> county Building Permit for ihe named individuals and propeny 2nd vnil remain valid (or Ihe term of the Build�ng Perm�t Expiration of lhis <br /> permit�vill require submittal of a new appilcation and fees PLEASE NOTE: repair permits are valid for thirty(30) days. <br /> PERMIT# Z�A74 — ISSUEDATF AI712013 TYPEISYSi[t�ARFPGIR rRAVITY <br /> nnaoac nnn na�nn <br /> Taz Account Number SubdivisioNLo�X <br /> Clavton <br /> Apphcant Name HuJd�ng Perm�l Flpp!�cant IJame <br /> 10119 15t PI W FverPtt <br /> Sde Address City <br /> INSTALLER <br /> I hereby certify this system was mstalled under my supervision and control and complies�i,h ail provisions of Snchr.m sh <br /> Health Dislrict requiremenfs and WAC 246-272, the S;ate On•Site Sewage Disposai Regula!�on <br /> Ins,aller Company Name HOh1EOWNER ev Date <br /> To be changed oniy w��.th 1=ealth Disinct concurrance <br /> � <br /> DESIGNER HEALTH DISTRIC"i / BM <br /> I hereby certify lhat this system installation complies with the <br /> criter�a of my approved design and wdh the requirements oF Final P.pproval By <br /> the Snohomish Health District and WAC 246-272, the State Date <br /> OrnSile Sewage Disposal RegulaUon Disapproved — BY <br /> Date <br /> Cornpany�$QVF AVERAC S PTI . �FSIC:NS <br /> Comments <br /> ;mal Approval By <br /> Date. <br /> Disapproved BY __ <br /> Date <br /> Reinspeclion Approval — 4Y - <br /> Date <br /> �omments --. <br /> DO ��OT COVFR BEFORE HEALTH DISTRICT INSPECTION ANU FINAL APPRQVAI_ <br /> y� <br /> 3020 Rucker Avenue, Suite 104■ Everett, WA 98201-3900■tel: 425 339.5250 �fa� 425 339 5254 <br />