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Utility Services <br />Attn: Monte Turner <br />Utility Sen�ices <br />310� Cedar St. <br />Everett, WA 98201 <br />� <br />s�bi��t: l0 7 � �f _ . � ...,,� <br />EXHIBIT "A" <br />,�. S � <br />My property is presently utilizing the following me#hod for sanitary sewage disposal: <br />� <br />Il <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 />►� <br />Il <br />Adequately func:ions. <br />poes not adequately function. <br />I plan to do one of the following: <br />I1 <br />0 <br />Connect within 60 days. <br />Request an extension for up to ten (10) years. <br />Signed. <br />�J <br />ROPERTY OWNER <br />� �� <br />� � � ��� <br />PHONE tvUMBEf2 <br />