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I <br /> Atln Michael Papa <br /> City of Everelt — Public Works <br /> 320U Cedar St. <br /> fvciclt, WA 98201 <br /> (425) 257-8810 <br /> Subject: _(Address) <br /> Connection to Available Public Sewer <br /> My properly is presently utilizin3 the following method for sanitary sewage disposal: <br /> [ ] Septic Tank Sy:te!n. <br /> � ] Connected to ihe Public S�nitary Sewer System (show proof or <br /> arran�c dye test`. <br /> Tn ihc best of my knowledge, my existing septic tank system: <br /> � ] Adeuuately functions. <br /> [ ] Does noi adequatr.ly function. <br /> I plan to, i( I am not already connected to ihe sewer: <br /> ( ] To connect within 60 days. <br /> or <br /> � ] I hereby request an exlension for up to ten (10) years. <br /> (attach Snohomish lieallh District certi(ica�ion) <br /> Signed, <br /> PI:OPL R iY OWNLR PHONE NUME3ER <br />