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� e� <br />,. __ _- .- <br />iART N0. — <br />rn nnSTING �-_ a�-_ <br />Sewer Applicatic�� and Permit <br />1i9s' <br />DATE 1`,�`i��` <br />Service Address �'4 nruakruJ Fd <br />Sema <br />Billing Address <br />. Evete[[ HA 98208 <br />Clry, State, Zip <br />' �ner Shirley il llordeen <br />Connecllon by n.M. ceuernl conecruccors_ <br />Address 513 k,ighvay 9 4141 <br />' l.k Steveue 41 <br />334-2140 <br />Phone <br />legal Deacription: <br />Lot 4 <br />OUO d-o0 <br />Block — <br />PI9l Johr.sons Addu <br />� Unplatted Description: <br />I —_�_ <br />� IG�w connectlun <br />, Type ol Permfl - <br />�1�� � j Remnrks <br />.:a,�i,.`, ._.._._._. <br />IMPORTANTI <br />CALL 1-800-424•5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPGCTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk $ <br />Leteral $ <br />Total Connection Cherge S <br />Utility Development Fee <br />Water $ <br />♦ <br />Sewer $ <br />Tolal Development Fee i <br />Sewer Bond District _ <br />Abutling Lol Line <br />N, S, E, W -- <br />Approved By <br />Issued By <br />Cuslomer Sipnature _ <br />^' ( . <br />�� i <br />,�n. o� <br />CO <br />; ��% <br />/ � <br />Inspectlon By . —' <br />Date Inspected � — <br />INSPECTION <br />, 2�a3� <br />