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Sewer Applicatian ��and ;Perr�ni�; w � f <br />_ _ ui ' 1 l <br />,.' 2965A ` DATE , _ _ 2n6/9a ; . - <br />815 N Hroaivay (units 334) <br />Service Address Utility Account No. <br />Billing Address 1429 Sroadvay <br />City, State, Zip h'wrntt 98201 <br />Owner SRCR A�soe <br />Walch Entrpri�e• <br />Connection by <br />Address <br />Phone <br />Lepal Description: <br />Lot <br />Blo�. <br />Plat <br />Unplatted Descriptfon: <br />Type Ot Permit C°p'�f <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />ALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART N0. <br />TO POSTING -�-'t <br />= �, <br />:: �= <br />,, <br />,.; :. <br />��� <br />� u J <br />� J!� _� <br />Permit Fee $ io.00_ <br />Connection Charge <br />Trunk S <br />Laterel $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water S <br />Sewer $ <br />Total Development Fee a <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W h• <br />Approved By <br />Issued By <br />Customer Signature <br />�� � <br />�"�'�' <br />u�o �;�� <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />29�sa <br />