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����: SNOHOMISH <br /> �, NEALTH DISTRICT <br /> WV'JVv.SNOHD.ORG Environmental Heaith Divis!on <br /> PER?`AiT TO INSTALL AN ONSITE SEWAG� DIS?OSAL SYSTEM <br /> This Snchom�sh �eaL•h O�s;r�ct P^rr:d lo ms�all an onste sewage d�sposal system is�•ahd cnly when issued r.onccrenfy wr,h the c.:y cr <br /> couNy �uilCing Permrt fcr the na�red irdrviCuals and F�cperty artl wlil remam valitl for tt,e lerm of ihe Build�ng Permd Eap�.r;�nn cf th�s <br /> permit will reGuire submdtal of a new appl�cation and fees PLEaSc NOTE: repair permits are valid for thirty(70) days. <br /> PER6t�T# 3fi874 ISSl1EDATE A1712�13 TYPEISYSTEM�ppIR C,RAVITY <br /> nn�aao nnn ns2oo � <br /> Tax Accuunl NumCcr S�bdiv�,icr/Lot# <br /> ClaytO� _ <br /> Apphcant Namc Bwld�n�Pcrmrt Appi.cant N�m� <br /> 101'19 1si PI W FvarPtt <br /> Sde Address City <br /> INSTALLE� <br /> I hereby cer,fy this sys;em .vas ;nstallea urder my sucervisien and ccntrol znC cemplies wdn all provis�ons of Snohom sn <br /> Health District reqwrements and WAC 246-272. the State On-S�te Sev+age Dispcsal Regulation <br /> InstaPerCcm�anyName H061EOWNER E�� �'" � D�te/i:' 'Z–�--'i3 <br /> To be cna--�.ged enry�mth Heai;n Dis!r�ct concurranc< . <br /> (__- — _.' —� <br /> � DESIGNER � H�i-+i.TH DISTRICF I BM• � � <br /> I hereby cert�fy that th�s system installation cemplies wdh the '�-. �f 2 r <br /> cntena of my apFrovea Cesign and with the requirements of F� al P.pprova,� �� � �i �J By ��� l,` �� <br /> the Snohomish Health D�strict and WAC 246-272, Ihe Sta;e <br /> Dafe � <br /> On•Srte Sewage Dis�osal Regula;icn Disapprove� BY <br /> Compa.iy T ( r <br /> Date <br /> Gommenfs <br /> Final Aoproval_�_ By /� � �'� <br /> Datc <br /> Disapproved � e BY _ <br /> Reinspection Approval BY — — <br /> Datc <br /> Comments <br /> DO NOT COVER BEFORE HEALTH DISTRICT INSPECTION AND FINAL APPROVAL <br /> 3020 Rucker Avenue, Suite 104� Everelt, �'JA 58201-3900s lel 425 339 5250 p fax. 425 339 5254 <br />