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EXHIBIT "A" <br /> Attn.: Kirk Brooks <br /> City of Everett– Publie Works <br /> 3200 Cedar St. <br /> Everett, WA 98201 <br /> (425) 257-8810 <br /> Subject: (Address) <br /> —'nnection to Available Public ewer <br /> My property is presently utilizing the following method for sanitary sewage disposal: <br /> [ ] Septic Tank System. <br /> [ ] Connected to the Public Sanitary Sewer System. <br /> To the best of my knowledge, my existing septic tank system: <br /> [ ] Adequately functions. <br /> [ ] Does not adequately function. <br /> I plan to do one of the following: <br /> [ ] Connect within 60 days. <br /> [ ] Request an extension for up to ten (10) years. <br /> Signed, <br /> PR PERTY WN R PH N UMBER <br />