Laserfiche WebLink
{..e.,� .. -: n.: ..........r,�.,i.,., . ..�_.�-�.�+--�_--�_ __�_ <br /> i . • ._ :'M1}1......\L�[i F:h'�.1✓.. .� . ��. .. . .. �. . . . . . .i. .� . <br /> ���--,--� iT�- <br /> n� �� :�-.: !�1.1 �.r. ��py�-h�.. <br /> A( <br /> CHART NO. <br /> . � <br /> q—�(�- q� <br /> «. <br /> t <br /> a�� � - -l w <br /> _ � � � g � � � � TO POSTING 4 ��' <br /> � ,.i o � ci v; ci o vi <br /> O' If� W +R � M U'] O� <br /> ISewer A • • n� •� p <br /> pplicatio��nd�p r�i# w <br /> , � � � � � � �� � � � <br /> �„ 2g546 � � � �°ii%�93 � .. � <br /> DATE <br /> Service Address Utiliry Account No. <br /> Billing Address 125 171st Pl SH <br /> Ciry, State,Zip _ Bo�hel I uA aani� Permit Fee <br /> $ 70.00 <br /> Owner as-�8ass{�Con�i Connection Charge <br /> Connection by C S Trunk <br /> $ <br /> Address Lateral <br /> $ <br /> Total Connection Charge $ � I <br /> Phone Utility Development Fee <br /> Legal Description: Water 179.00 i <br /> $ <br /> Lot SeWQ� 471.00 <br /> Block $ <br /> Total Development Fee $ 650.00 <br /> Plat <br /> Unplatted Desc�iption: Sewer Bond Dfstrict <br /> Abutting Lot Line <br /> N'S' E� W ft. <br /> Type of Permit Nev connection <br /> IApproved By <br /> Remarks Issued By gb <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By_��c� �iecy.� <br /> I __,. � Date Inspected 3' ��45� <br /> i <br /> ISEE SKETCH ATTACHED I <br /> � INSPECTION , 1� 2�5 4 4 I <br /> — -------- --------------- -------J <br />