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_ .__ . <br /> _ _ _--- -� <br /> CHART NO. .—___ <br /> Sewer Application and Permit <br /> ? ��' �� DATE . s/z�/�2 � <br /> Service Address 3003 W Ceoino 40-60 IIlde Udiity Account No. <br /> BIIIIngAddress PU eox 3707 MS/OF-1G , <br /> Clty,St81e,Zip Seattle WA 9E124 Permit Fee $ 30.00 ! <br /> Owner _ a�eino Connection Charge � <br /> i <br /> Connect(on by Trunk $ <br /> ; Address — I <br /> Lateral g � <br /> Total ConnecNon Charge $ I <br /> Phone _ Utiliry Development Fee <br /> I <br /> Legal Descrfptfon: Water g I <br /> , �� Sewer g I <br /> I' Block � <br /> Total Development Fee a i <br /> I Plat i <br /> i <br />� Unplatted Descriptlon: Sewer Bond Distdct i <br />' � Abutting Lot Line � <br />'; i <br /> I <br /> i ' N�S� E,W g. i <br />; Type of Permit Alearation Approved By � <br />� Remarks Issued By � I <br /> Customer Signature '� '�� � � <br /> ' / I <br />' IMPORTANT! <br />; <br /> CALL 1-800-424-5555 48-HOURS � <br /> PRIOR TO DIGGING I <br /> CALL 259-8810 FOR INSPECTION �nspectlon By '' <br /> Date Inapected '� <br /> SEE SKETCH ATTACHED ' <br /> INSPECTION ;, 2(j$Q � <br /> � <br />