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--�- ---- - --- -- <br /> _ ----- - --- - __ . <br /> ;� ,. . .�.�.:: r <br /> � <br /> CHART NO. -- <br /> ' � <br /> ��� <br /> TQ P�STlNG�.-�3�,.,L <br /> C.�`1. H �� -i . ,_, .- . . . ._ _i <br /> 9 H tn � <br /> H �H <br /> rG C) <br /> yN� , Sewer Application and Permit . , ,; <br /> oy� „ ; ;, �. ., _ . <br /> � �/�i E `i-15-n? <br /> �"�� � Service Address 19'2 �:ncl,nd Av, Utilily Account No. <br /> � y� Billing Address ''U 3on 1116 <br /> g y F.i , City, State,Zip Lvnnwood WA 9804b Permit Fee $ ���'��� <br /> c� C7� <br /> � �� Owner �.L i:�, :till�r Connection Charge <br /> zyfn �i wnar {-C. .xV�✓tSu.� �7p.no <br /> �3 o rn Connection by Trunk $ <br /> Address Lateral S <br /> Total Connection Charge $ =���•�� <br /> � <br /> Phone i43-3213 Utility Development Fee <br /> �"°_ Legal Description: Water S '-=��•��� <br /> �� � <br /> ' Lot 6 oi �Riitc Cliffs of !)ov•�r Sewer $ 50�•�� <br /> ��" ''�� Block TotalDevelopmentPee $ ��;.no <br /> e � <br /> Plat <br /> �� � I Unplatted Description: Sewer Bond Districi I j <br /> I Abutling Lol Llne <br /> ..,. � N,S, E,yJ ft. <br /> TYPe of Permit ';i.'; Co�r;i'r,Tiort Approved By <br /> �_,;�� Remarks Issued By 't" <br /> � Customer Slgnaturo <br /> + � I IMPORTANT! <br /> , CALL 7-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> Inspection By �����' ' �"�'� <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected � Z -i"! "�i z <br /> , � <br /> SEE SKETCH ATTACHED <br /> WSPECTION ?¢9� � <br />