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� <br /> . i <br /> _. I <br /> CHART NO. — .__ � <br /> r:r,. <br /> � <br /> ��� ; . <br /> ��� TO PO`T�n�r� s s."s3 i <br /> m H t~i� I I '. <br /> H �� .. ,,:��:'.�. <br /> � �� Sewer Application and Permit � � � �������� i� <br /> fA H <br /> lT7p� � �t � � � 1(�/f:/�0 <br /> o N t7 DATE ____.._ <br /> ��g o�u�:� <,�.d: F�� — <br /> H Sarvice Address —. __--—_— Utility Account Na. — <br /> z y� 4004 d9rd Ave S� , . . . ,�,. <br /> z Billi�g Address - <br /> a.y'c <br /> 7h:�?p j "' ' <br /> g y H City, Slale, Zip — �et�S�wA 96P0� Permit Fee $ ----- '},';- . <br /> C] C7 y <br /> ��t+ OWnC� —_ ��Y�nSq '��n��' Connection Charge <br /> y�y Connection by _ Trunk $ <br /> Address Lateral $ -- <br /> _--__ Total Connection Charge $ 0.00 <br /> Phone _ __ Utility Development Fee " " <br /> '�� Lega�Description: Water $ 261.00 <br /> + Lot 3 Sewer $ bD0.00 <br /> ("' � Block __ __ Total Developmant Fee S 940'��� <br /> � � <br /> Plat SP 47-S1 <br /> (�' = Unplatted Oescription: Sewer Bond District I ??. , <br /> r �:��_ <br /> _ Abutting Lot Line <br /> (� N, S, E, W fl. <br /> �� 1 <br /> Type of Petmit ��Rv connrction Approved By i � <br /> �� I 1 Remarkc ti�a�er erzvic• purchee�d 4/16/92 - Issued By_ —_ �'�{ <br /> "�' S.o. �� <br /> __ Customer Signature � <br /> �� � IMPORTANT! S �,�.II� �� �r,� ��� �,. �.. /in,�:�-�� ' i <br /> l0� �,� , /I � � n� ., ,..�" I <br /> _� CALL 1-800-424-5555 48•HOURS rL %"�y/" r^ „ / /�� �' ��• I <br /> PRIOR TO DIGGING 7r',r� � „�;j���� ��l„�A�� � <br /> Inspec�ion By_ j <br /> CALL 259-8810 FOR INSPECTION <br /> oaie i�c�ed y- '� -`r � <br /> ' I <br /> SEE SKETCH ATTACHED <br />� INSPf:CIION � � - <br />