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) i '� SNOHOMISH FNVIRONMENTAL HEALTH DIVISION <br />� Water 8 Waslewater Section <br />I� HEALTH 3020 Rucke�Avenue, Suite 104 <br />[verett, WA 98201 �3900 <br />DISTRIC7 425 339 5250 <br />—__ —HealthyL!/estyles,HealthyCommunities —�-- - <br />PERMIT TO INSTALL AN ONSITE SEWAGE DISPOSAL SYSTEM <br />fhis Snohomish Hoalth Districl Permd to mstall nn onvite sev.�age disposal system is vaGd only when issued concurrentlywdh Ihe cdy or <br />county Building Permil for Ihe nameA indiviAuals and property and K�ill remain vahd lor the term M the Bullding Peimrt. [xpva6on o( Uiis <br />permil will reqwrr, submitlal of a new xpplication and fees PLEASG NOTE: repalr permlta ara valld for thlrty (30) days. <br />r�rkn�ir a 35071 ISSUE DATE 8/26/2009 _. TVPe i srsTr.M REPAIR GRAVITY <br />005354 000 01600 _ Olivia Park Div 3 ___ <br />i;�x Accoun� Number u rv�swn ot <br />Clark <br />pp ican anTl�ie —�- �wlding Permd Applicant N�me <br />2121 106th St SW Everett <br />'.irrt�-rr1Art.^�s--�—� Z.`ily- <br />INSTALLER <br />I Pc reL� cerhty thir system was instailed under my supervisien and conlrol and complies with all provisions of Snohomish <br />l i.�alth Distnct mquirements and WAC 245-272, the State On-Site Sewage Disposal Regulafion <br />Installer Company Name HOMEOWNER By _____ Date <br />To be c ange on y wi ea i is nc concnrrance <br />DESIGNER HEALTH DISTRiCT / B �8 423 <br />I hereby certdy lhal ihis syslem installation complies wdh lhe ���- <br />cnteria of rny approved aesign and wilh the reyuirements of Final Approval �� �' � By <br />the Snonomish Heaith Dislrict and 61/AC 246-272, ihe State ��` e <br />On-Site Sewage DisFosal Regulation Disapproved . __ �y _ <br />� � Datc <br />Company_ BRENT HACKNEY _ <br />Comments <br />;nal Approval_�i ZX•c,,�_ _. By �,� _ <br />Datc _ _ _ <br />t)isapproved _ e�-By <br />Remspection Approval a�e BY <br />C:ommen�s <br />DO NOT CUVER BEFORE HEALTH DISTRICT INSPECTION AND FINAL APPROVAL <br />u�,-zn «l u� inui�� <br />