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Sewer Application and Permit <br />23ni' <br />DATE Sepae.a6er 24, 1992 <br />CHART NO. <br />�,., :TO POSTING 9-z �-yZ <br />�tl <br />G 4' . <br />o n„ <br />O 4� _�1 <br />Service Address 717 Grund Ava Utility Account No. — <br />Billing Address same <br />City, State, Zip evnrect. �Jn v&201 Permit Fee $ <br />Owner Connection Charge <br />for L.�mage <br />Connection by North Lake Utiliciee HeDuir Service�)unk <br />Address PO Box 1691 Lateral <br />I:oodinville 98072 Total Conneclion Charge <br />Phone 481-9212 <br />— Utility Development Fee <br />Legal Description: Water <br />Lot Sewer <br />Block _ Total Development Fee <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks _ <br />Re�nir <br />IMPORTANT! <br />CALL 1-500-424-5555 48•HOURS <br />PRiOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Sewer Bond Disirict <br />Abutting Lot Line <br />N, S, E, W _ <br />Approved By _ <br />Issued By <br />Customer Signature <br />10.00 <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Mnrgaret DfcLeod <br />Inspection By �����u"^ <br />Date Inspected �"� y"� Z <br />INSPECTION <br />�� <br />4 <br />5 <br />, . , � :���, <br />