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Snohomish Health District Property Tax Account �70. ��-DO/-o.13—���7 <br />Euvironmental Heaith Divislon <br />Courthouse, Eyerett, Wasiiington Plan Check No. <br />259-9473 <br />NOTICE: REVIEW AND PROCESSIt�G FEE 01' $25.00 IS PAYABLE UPON.ISSUANCE OF THE BUILDIFlG <br />� PERb1IT.. <br />CLEARAtJCE for Constructlon with Existinp On Site System <br />Owners I�ame: �3���Ec ��d, iNc. Phone: 7�{,,�EJ's�s�Date:_ �— Z—�( <br />Si te Address:�S �3 "' /B TN fI //� . LJ. City :� �/�=��TT <br />Contact Person:, �fJ2G �,�,'�„� Phone: 7�3 -6S-�S� <br />Contact Person's Address_�/ ? 6 S�2%n��. �� Y, L%✓�✓�✓00� <br />Site Legal Description/Lat No:: 33 -%/�'-r2C/iY c7�2q�•� Te9cT-S <br />S�c ./.� � Tr✓P 23 2 o.s= . a� ong ega — <br />:.:•plain project end its use: (Room addition, garage, barn replacing Robile hon�e, <br />Temporary Conditiona�/_ 1 Use) <br />� ' <br />%�c� ac-, -._-.� ✓�, � f� ��. '� r-e��-�-P — <br />Indicate total numbar of bedrooms before and after construction: __f <br />ATTACH COP1' OF PLOT PLAT: f�" X 11°.minimum si,nwfng: � <br />1. Dimensions of property lines 5. Roads, easements� driveways, parking <br />areas <br />2. bimensions of existing sicructures and 3�-�23 <br />their distance to lot lines. 6. Well location �°�3° ���� r <br />3. Dimensions of proposed construction l. North arrow <br />4. Location of septic tank and drainfield; • <br />if known. • <br />� <br />" URFVlING I <br />Homes Constructed efter 1977. Property tax account number used, <br />Homes Constructed 1955 to 1977: Provide: Name nf Builder: <br />or Name ��f First Owner •, and Year of Construction <br />Applicant S1 <br />RcFIARKS ' <br />Denied by_ <br />Approved by <br />JC�N 1�AS � <br />PAID N <br />Snohomisft w <br />Health Oistrtc� �q�� <br />2�5. <br />� n, <br />uate: /(�� <br />Date:i l� <br />