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(17 SNOHOMISH <br /> ' ‘bd HEALTH DISTRICT <br /> 111 <br /> W W W.SNOHD.ORG Water and Sewer Adequacy/Food& Community Safety <br /> Facility name Eight Ball Cafe <br /> HEALTH DISTRICT <br /> Site address <br /> 2727 Colby Avenue USE ONLY <br /> City Everett State WA ZIP 98201 <br /> Parcel number Proposed number of seats <br /> Contact name Rachid Ayouni Phone (206)841-4070 <br /> Email <br /> rachid.ayouni@gmail.com <br /> ❑ New construction a Remodel/Alteration ❑ Expansion of existing restaurant <br /> U Yes ❑ No Is facility connected to a septic system? <br /> ❑ Yes ❑ No Are public restrooms available? ❑ Pre-approved water system <br /> Yes U No Is a grease trap required by sewer district or building department? <br /> Describe the proposed project: <br /> Sewage system ❑ Sewer bill attached ❑ Below completed by official <br /> This section should be completed by a Public Sewer System Official, if a sewer bill or availability letter is not provided. <br /> Name of system Sewer utility <br /> The above system will provide service to the facility listed at the above address. <br /> System official Phone Date <br /> Water system <br /> This section should be completed by a Public Water System Official, if a water bill or availability letter is not provided. <br /> Name of system State ID number <br /> The above facility ❑ is connected ❑ has applied <br /> The above system will provide service to the facility listed at the above address. <br /> System official Phone Date <br /> HEALTH DISTRICT USE ONLY <br /> On-site <br /> Approved to submit(signature) Date <br /> Final septic approved (signature) Date <br /> Water <br /> Name of water system State ID Number <br /> ❑ Not adequate for use <br /> ❑Adequate for use (signature) Date <br /> Comments <br /> s t` <br /> Environmental Health Division r` f <br /> 3020 Rucker Avenue,Suite 104 ■ Everett, WA 98201-3900 ■ fax:425.339.5254 ■ tel:425.339.5250 <br />