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� ---. _ - - ---- ----- - ---,--_-_- <br /> CHART NO. <br /> i <br /> I Sewer Application and Perrn,it _ �n PaSTING �as-�� <br /> II :�_ �1 - I , <br /> ! , 2 �5 f13 DATE �i-5-93 _ - � <br /> ServiceAddress , 1G e I�iEnCITY AVr: , <br /> , Utiliry Account P+o. <br /> I Billing Address <br /> I Ciry, State,Zip EVERF.1"f WA 9H%OFl Permit Fee $ 3C�,00 <br /> I Owner ��DLEY BnXTER Connection Charge <br /> � <br /> ' Conneotion by Trunk $ <br /> i <br /> j Address Lateral $ � <br /> I Total Connection Charge $ <br /> ' Phone Utility Devetopment Fee i <br /> i Legal Description: Water $ <br /> iLot Sewer $ i <br /> ' Block Total Development Fee $ <br /> � Plat <br /> iUnplatted Description: Sewer Bond District � <br /> I <br /> Abutting Lot Line i <br /> I N,S, E,W ft. j <br /> � Type of Permit ALTfiIiATIOn qpproved By � <br /> Remarks Issued By '�H I, <br /> � Cusromer Signature <br /> i <br /> iIMPORTANT! <br /> � CALL 1-800-424-5555 48-HOURS -� <br /> � PRIOR TO DIGGING � <br /> i CALL 259•8810 FQR INSPECTION Inspection ey <br /> Date Inspected D Q I <br /> � <br /> SEE SKETCH ATTACHED ' <br /> INSPECTION : � ��L` .�+ <br /> I _ - - ------------ — -- � <br />