Laserfiche WebLink
�4 SNOHOMISH HEALTH DISTRICT <br />Watar/Wastewater Ser:tion <br />3020 Ru,:ker Avenue d10�1 <br />Everett WA 96201-3900 <br />425.339 5250 <br />Property Tax Account k '��`� 5�� "� `- � � " � � � �' <br />Itl:(�l'1�:5'1' I�OK RI•:Pf)R"f ON AN <br />O\till'I': tih:11'AGI�: UISPUti:11. Sl:ti'I'l�:Jl <br />�l hcck hu� if apph:�:won mcluJ; , 1t'a�cr Hcp,�rt Rcqut�t <br />.inJ allach cunq�lcicd ;ip��lic.ni� �n <br />' vr.it <br />Proporty Addross •' 2�4 � z 1„` 1�� Si_ -- �'N � <br />MAIL REPOFT T0: f�s�_c�q�'rlv nrinl iuu n�m�$ <br />csmW�� � sLv�insdu_cf�n9.�s? Eo�c. > <br />i�.,. ,1 .>�,r�N <br />22�:y �2Z^`� I�L 'it <br />9ddress <br />t�ea� �vn '?e.��r <br />iryi v ip <br />Logal Description: Sec. <br />ApplicanYs Name ! 4' <br />�1N1qrSi�8R10 �4�•` <br />Twp. Rng Lot a <br />VUT \':�I.ID <br />4NI.EtiS <br />�U'PI.IC,�I'IUN <br />is onri•: s Fr:r: <br />ST�151PF:D ftl' <br />5\UIfU\I1511 <br />ItGAI.T1i <br />DICI'ItICT ... <br />SHD OFFICE USE ONLY <br />,._,�. <br />Phone l 92�i ) 3l a• a:c <br />Phone �9Y5) 3l'�- '12i•I <br />Is house occupied? �Yes ❑ No II not, date vacated <br />Yearhousebuilt �y�=� Numberofbedrooms '-' <br />Date septic tank last pirry�ed �'„'w�-�.., Pumped bv Un4„„�., <br />Has tho septic syslem failod or Tallunctioned? ❑ Yes [�}'No Explain <br />Has tho septic system been repairod or altered? Qi'os [�'No Doscnbe <br />Since now, has ihe hame had any additions? �Yes [,�No Describe <br />App6cvit Signature �' Date I b- Ma �- 2w� <br />NOTE: Any liald inspection conducfed hereunder is limifed fo a visual inspection ol fhe site fo observe si9ns ol septic <br />systom lailura presenf on Ihe ground suAace or suAace wafer, and visi6le physical leatures which may rnpair the proper <br />operafion o/ fhe septic sysfem. This report does nof constitufe a representation, warranty, or guaranfeo as fo whether or <br />not the system is actually lunclioning at fhis fime, nor representafion or warranfy as fo tho luture lunctioning o/ fhe sewago <br />disposal system. <br />For Hc:illh Dislrict Usc Only <br />Field Inspection Uate _,�f zil o� �As•Built on file. � As-Built not on file. <br />1. �j Sewago disposal system appoars to be lunctioning at time of inspection. <br />2. ❑ Sewage disposal systom appears to be malfunctioning at time of inspection (ownPr to be notified). <br />3. ❑ Home vacant at time ol inspectron, system not in operation. <br />4. �] Snohomish Health Distnct records indicate Ihat the seplic tank has not been pumped within Ihe last 2�/2 • 3 years. <br />5. ❑ There appears to be a poNon !approx. fecq ol drain6eld locar�d under _ <br />Commems <br />siyn�i� _ �' w�-�-��, __ �,�� 3��3 u� <br />�, „���r�,,,,:�� ri�,ar, i��•. ������� <br />� S1 <br />�{u - ,. .���:I I,li� <br />�[ <br />