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.�N'v A�'- il...,:y <br />.�, — .- <br />�. — p — �i r.i — � <br />. � , ' i '� . r r_" <br />, �; �- <br />; <br />Sewer Applicatio�.,�n'�l;i�e�mit-, LL ry <br />.i7 J'i C� i c —.4 C' '�_ <br />._ � �. �� i ��� _ �.�iC�� <br />�� s.,� -: w . .. .._ i ... ... . <br />�..: 29652 rDATE 2/i5/9a <br />815 N Broadway (units ZZ-ZS) Utili Account No. <br />Service Address h� <br />Billing Address 1429 Braodway <br />City, State, Zip Lroarett 9�i201 <br />�yy�� SRCR Asaoc <br />Connection by Welch Bnterprisee <br />Address POB 366 <br />Nc Vernon 98273 <br />Phone <br />Legal Description: <br />Lot <br />t7[�^3 <br />Plat <br />Unplatted Description: <br />Type of Permit Cap-of f <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />� rs� !�'v""".z'ur'°%.�s�� <br />CHART NO. <br />TO POSTIN �� �'r <br />PermitFee $ 10.00 <br />Connection Charge <br />Trunk � $ <br />Lateral S <br />Total Connection Charge $ <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />SE�wer Bond District <br />Abutting Lot Lfne <br />N,S,E,W _ <br />Approved By _ <br />Is.>ued By <br />$ <br />$ <br />$ <br />Customer Signature <br />f ' s,e (a� <br />o � �� <br />, �,' <br />� <br />Inspection By <br />Date Inspected <br />INSPECTION <br />',' 2�Jfi5? <br />n. <br />