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(17.4Q SNOHOMISH <br /> � <br /> k HEALTH DISTRICT <br /> �� VVYV\�sNOHD{}RG Water and Sewer ,A ^ Food & <br /> Community Safety <br /> MJ CAFE <br /> Facility name <br /> HEALTH DISTRICT <br /> { <br /> 151323RDST USE ONLY <br /> Site address <br /> EVERETT WA 98201 <br /> City State ZIP <br /> 13 <br /> Parcel number Proposed number of seats <br /> MARY JOYCE TAL|yWAN 4254188191 <br /> Contact name Phone <br /> MJCAFB0@GMA|LCOM <br /> Email Fax <br /> d New construction GIRemodokAJharaton U Expansion of existing restaurant <br /> 0Yeo di No Is facility connected to a septic system? <br /> W� <br /> Yes w/ No Are public restrooms available? LI Pie-approved water system <br /> 0 Yes ip No Is a grease trap required by sewer district or building department? <br /> Describeproposed ` <br /> We || beoddih0 (1)3 (�o ~ sinks, (2) handwash sinks(1) Fruit sink (1)Utlity sink and adding counter spaces. <br /> • <br /> Sewage system GI Sewer bill attached [� Below completedby official <br /> This section should be completed by a Public Sewer System Offioia|, 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 /> State |Onunober <br /> �omaof���m <br /> The above facility U is connected U 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 systState ID Number <br /> U Not adequate for use <br /> U Adequate for use (signature) Date <br /> Comments <br /> Environment.] Health Division <br /> 3O2ORucker Avenue, Suite l04 • Everett, VVA9820l-3900 • fax: 425.339.5254 • tel: 425339.535O <br /> Vis;) <br />