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,_,. . , • ... - . <br />_.... .,�. ....�.._"f'y�T,,'•-�-_'__i".!. .�.�.:.� A.�.,��.,Cs-.rs:�:r.' <br />�'�r�+�� .rta-. <br />� .� <br />Sewer Appl <br />?900"a <br />-�,,:—_ - --- <br />CHART NO. _ <br />'�z: <br />� <br />p[J (l fz'� fl : i�� Q i"_ <br />� ;:1 C,. 1�1 �, bt �:J !J � t.: <br />p-� .-� C�_ ' d � O �J '- Eq <br />_ �� � ht . �':1 ., J ,. t=. <br />iN , K [! <br />�. .]�µ �l ... <br />ication ��nd Perr,_riit � , _ <br />� <br />ni c. r_^� .� '^ �p G� rJ �.1 O u � U� <br />['J G Ci � J v r,D ;: -' r,� �- �'� 3 C W <br />p �` t_I .J �` _I C�.. :.7 J � � <br />C� 2`. fi; ::L u� Gi Q i: :': ?: :Y !:J % <br />DATE 12-z3-92 <br />Service Address Z16 Madison St <br />Billing Address PO Box 2577 <br />City, State, Zip Lynnwood SdA 9803G <br />Owne� Ifomewood Development <br />Connection by �"1e1 <br />„.Address <br />Phone 776-2634 <br />Legal Description: <br />Cot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit vew connection <br />Remarks <br />IMPORTANT! <br />CQLL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />� ;, , <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />— ', <br />?4! ��fT�NG ��Z9 / 93 I <br />-----�_ <br />PermitFee $ ��•00 <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abutting Lot Line <br />ra, s, �, w _ <br />Approved By _ <br />Issued By <br />Customer Signature <br />I (retired) <br />174.00 <br />471.00 <br />650.00 <br />t�i <br />� l .,_. ,� �( . �, � _.� ..� <br />Inspection By ��----- <br />Date Inspected �- �� y 3 <br />INSPECTION <br />• 2_c,i 03 <br />ft. <br />u <br />