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-� <br /> .,,� <br /> � <br /> ,� � <br /> . _ <br /> CHART N0. -- ------ � <br /> ��y TO P(1CTINf, S u,-�y <br /> �O x1 CC �? <br /> Q H <br /> ayw <br /> H �� <br /> � H� Sewer Application and Permit <br /> V1 H <br /> H <br /> '� <br /> � Qyd ' '�� ' DATE "/zi/��t <br /> OH <br /> Fy � LJ07 l.n�ip :"I A L ll <br /> c'�� Cc'� Service Address — Ut�G;y Account No. <br /> z H 3 G004 �3rd Av� SL. <br /> � H�*7 Billing Address - <br /> H'� I:veere[t WA 98205 ��'�� <br /> g y H City,State,Zip Permi�Fee $ _ <br /> n C y Uenni• Janke <br /> � �,�� Owner Connec�ion Charge <br /> y a y Connection by Trunk $ <br /> Address Lateral $ <br /> Total ConnecGon Charge $ ��'��� <br /> Phone _.___—_ .___-__ _--_ __ Ulility Developmenl Fee <br /> .t.. .� Legal Description: Water $ 2G1.OU <br /> '�! Sewer $ 688.OQ <br /> Lot ----------- - <br /> � �i Block — Tota: Development Fee y 949.D0 <br /> � � <br /> Plat a'c�-yt <br /> � �� Unpiatled Descrlptlon: __ Sewer Bond Disirict <br /> � <br /> Abutting Lot Line <br /> �I I — N, S� E,W ft. <br /> Type of Permit t;ev connection _ Approved By <br /> 1 �'� Femarks Issued Oy_ Cn <br /> �. � <br /> Cus�omerSignature. — <br /> � �I IMPORTANT! �, /I" ,�� � ;ns������ <br /> � I�S ` ��t����� j° � ,. ,�' <br /> CALL 1-800-424-5555 48-HOURS `��� � ��Q-� �A�` �,���� `�� r/ � � <br /> ' PRIOR TO DIGGING � " nID ..� ���,� � „J� <br /> Inspection By �1��^� 5�/�F � � <br /> CALL 259-8810 FOR INSPECTIOp1 <br /> Date Inspeated '' _ '� � <br /> SEE SKETCH ATTACHED � <br /> INSPECTION - <br />