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, z-=- ----_. <br />p <br />Sewer Application <br />�;^ 29t4L <br />DATE <br />Service Address 5910 Heverlq Lane , <br />Billing Address D°m° — <br />City, State, Zin �varett WA 98203 <br />Owner Micchel Cogdill <br />Connectlon by �r Teneea Const Inc _ <br />Address � B�x 104 <br />Hukiltao WA 9A275 _ <br />Phone 335-6682 <br />Legal Descriptlon: <br />Lot <br />Biock <br />Plat <br />Unplatted Desc�iption: <br />7VPa of Permit �l I� ����� ��t�,r_ , — <br />Rcimarks — <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIa7R TO DIGGING <br />CALL 259-8810 FqR INSPECTION <br />SEE SKETCH ATI'ACHED <br />Utiliry Account No. <br />Parmit Fee $ <br />Connectlon Charge <br />Trunk <br />� <br />CHART NO. — <br />TO P�STiM� �-.t3-�3 <br />30.00 <br />Lateral <br />Total Connectfon Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />S <br />$ <br />3 <br />Sewer Bond District <br />Abutling Lot Line <br />N, S, E, W n' <br />Appruved By . <br />Issued Ey.__ � � <br />Custcmer Slgnature <br />i � <br />Inspectfon Cy 'y"4�� <br />Date Inspected G �' � � � 3 <br />INSPECTION <br />:.�:, 2�;d0 <br />