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! <br /> .. ` <br /> CHART NO. -- - ------ <br /> ��5 TO POSTING. -_<<-� <br /> .O � <br /> >Ht~/� . . . . <br /> o �o Sewer Applicat�on and Permit ; <br /> � �� <br /> � x� � '% '- � DATE �12i�/a: _ <br /> : <br /> � �C Service Address �61U C Cedy Rd UtlGty Account No. � <br /> � PO Bx 2266 � <br /> H� � BillingAddress � <br /> > y� Ev�iett WA 98203 70.00 <br /> r� H y City, State, Zip Permit Fee $ _ � <br /> Lyle 6. Blank � <br /> g d y Owner Connectiou Charge <br /> � t�� Connection by --- Trunk $ i <br /> O ti Address Lateral E ( <br /> __ Tatal Connection Cherge $ � <br /> Phone _ — Utility Development Fee � <br /> � Water $ t79.00 { <br /> Legal Description: ` <br /> � Sewer $ 471.00 <br /> � �� Lot � <br /> ! ' � Biock — lotal Development Fee $ 650 00 <br /> Plat :�P I1-92 � <br /> �� �' I (ietlrad) � <br /> � i � Unplatted Descdptlon: Sewer Bond District � <br /> i <br /> ,v, � I _ Abutting Lot Line � <br /> ' ! � N, S. E,W -- R' <br /> � <br /> Type ol Permit Nav mnn�ction Approved By <br /> �„ ,� CB <br /> ' Remarks _ _ Issued By — <br /> _. <br /> � ry�� <br /> Customer Signature ' ` �� ���" <br /> ._ — <br /> � <br /> IMPOHTANTI � <br /> —��.. I CALL 1•B00•424•5555 48•HOURS I <br /> PRIOR TO DIGGING � <br /> Inspedion By ��"��"�"' I <br /> ` CALL 259•8810 FOR INSPECTION �� _�f s.l <br /> _�- . – • ' � Date Inspected _ <br /> SEE SKETCH ATTACHED � �r 2 � <br /> INSPECTION - ' <br /> I <br />