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. .. , t,,, .� .. . .. .� . ';: _ , .s.. , ., � CHART NO. .. , , . .� <br /> � <br /> x <br /> � <br /> � � � R <br /> � � o � <br /> I"• � M a <br /> i•± <br /> Sewer Application anc�R��t�?�t <br /> � �� � � � <br /> �j :L Li .-05 i� J <br /> � , 29738 DATE 5-St9i <br /> Service Address <br /> 2132 Grand Ave Utility Account No. <br /> p0 bo: 122 <br /> BNli�p Address 10.00 <br /> C� �� � Snohaeish WA 98290 PermitFee S <br /> �o=g� Fiech•r Connection Charge <br /> Owner s <br /> Trunk <br /> Connecticn bY s <br /> Lateral <br /> Address <br /> Total Connectbn Cherye S <br /> Utility Development Fee <br /> Phone s <br /> Water <br /> Lepal pesaiptlon: a <br /> Sewer <br /> Lot <br /> Total DevelopmeM Fee S <br /> Bbck <br /> Pkt <br /> u������. —_�_ Sewer Bond District <br /> Alwttirp Lot Line <br /> n. <br /> � N,S,E,W <br /> � ff � ppproved By <br /> Type of Permk � <br /> �4e � �sa�ed sy <br /> Rema�Cs 3?i o <br /> � Customer Slpnature <br /> Q <br /> u 5 IMPORTANTI <br /> � � <br /> CA�L 1-800-4245555 48-MOURS � �3 � <br /> pRIOR TO DIGGING � 1 <br /> Inapectbn By <br /> CALL 259-8810 FOR INSPEC110N � Dete Inspected <br /> SEE SK�'TCH ATTACHED ,'? 2 9 7 3 $ <br /> INSPECTION <br /> —------"--- <br />