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r_--_ -,___" r, "' ___'"'_ . <br />m <br />I- -L-- - � __ _T .- .. . .__._. <br />CHART NO. —__ <br />TO POSTING � �� <br />- � _ ; �; - <br />_. _ � 7 ..•'• <br />. . " . l 'J 4-i t ,I <br />� � V� i! <br />Sewer Application and Permit_ `� � � <br />� �� <br />. � �. �� � _ ;�: <br />�- � _ . - <br />- r.` �- _ �.,, <br />Z ��'� ; p DATE 1%2e/9c : . - ; _ , __ - <br />ServiceAddress ynil Colby <br />BillingAddress 528 91et Avo NE <br />Ciry, Slate, Zip 98205 <br />Owner Cronin llev <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplaqed Description: <br />� Type of Permit <br />I <br />I Remarks _ <br />Ne�.� connection <br />IMPORTANT! <br />� CALL 1-800-424-5555 48-HOURS <br />� PRIOR TO DIGGING <br />I CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utiiity Development Fee <br />70.L4 <br />� <br />Water $ 174. (!�� <br />Sewer g 471.00 <br />Total Deveiopment Fee $ 650.00 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W ,_ <br />Approved By <br />Issued By <br />Cusromer Signature . <br />�b <br />Inspection 8y��—�___ <br />Date Inspected �' Z Z— 9 y <br />i INSPECTION � q � � ^ <br />� <br />R. <br />