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A�7x <br />9Ht~/r <br />y�H <br />�e c] <br />H �1 <br />O x0 <br />� V! Hr�+ <br />�O� <br />� N <br />H�8 <br />��-1 Y (% <br />y> N � <br />C" H <br />H <br />y <br />g d �, <br />�o� <br />Sewer Application and Permit <br />� - - ---, <br />CHARTNO. — _____ I <br />� <br />Tn oOSTING '-9-4� <br />__���. <br />�'�' �1/; ���, <br />.� DATE --- — <br />ServiceAddress '�1�, �ul�er <br />-- — Ulility Accaunt No. <br />Billing Address 1U127 21et Ave u <br />Cfty, State, Zip F.verecc Wp 98204 Permit Fee $___ <br />Owner iu�+� •�,�*ich ConnectionCharge <br />Connection by _ Trunk $ <br />Address _ Latera� S <br />— Tolal Connection Chargo S <br />Phone ________________._._ Utility Developmenl Fee <br />Legal Description: Water $ <br />Lot _ Sewer S <br />' Block —_ Total Development Fee E <br />JO.iiO <br />; P�a� BrldEewa7 <br />Unpiatted Description: Sewer Bond District <br />Abutting Lot Llne <br />N, S, E, W_ ry, <br />Type ol Permit ai rQr,,�+��� _ Approved By <br />Remarks _ Issued By _ �:b <br />— Customer Signature % � -��" , � � � � <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGIN(i <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />f/ ' <br />Inspedion By � "���`� - <br />Date Inspected � G > > <br />INSP[CTION <br />9 � ' ;j !1 � <br />