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j . .� <br />I C�� <br />�� � <br />il, _ <br />r�,� <br />�--- - ---- -- <br />__. <br />� <br />TO POSTINf..�?�--Z <br />Sewer Application and Permit <br />DATE "��,,:,�.�z za, i��� <br />Service Address <br />IIO'? ,rand Ave. <br />Billing Address <br />L:verett F7A °�'�l <br />City, State, Zip <br />Owner ', �:� ^' `�, <br />Connectionby �1i�'MOuntain Conti-�a`-°= � <br />Address F� � 577 <br />�allewa, wA ��009 <br />Phone 347-5155 - <br />Legal Description: <br />Lot _�— <br />Block _ � <br />Plat <br />Unplaried Description: <br />Type ot Permit `�-' ��'r`,�— <br />Remarks ._. <br />i IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />I PRIOR TO DIGGING <br />I'I CALL 259-8810 FOR INSPECTION <br />I SEE SKETCH ATTACHED <br />N <br />Utility Account No. <br />CHART NO. <br />� illi I.c;'i'ru <br />Wc� $30.0f' <br />r. t0.oi <br />PermitFee $ 30.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Total Conneclion Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />�c�01�'�0i � <br />Sewer Bond District <br />Abutting Lot Line <br />n. <br />N, S, E, W <br />Approved By <br />Issued B T 'A��,"'�'11 _�`_ <br />Y _ � <br />; /.� .�. /i%, , �; <br />Customer Signature <br />. /.; ; <br />Inspection By � � � � . �� <br />Date Inspected J � <br />INSPECTION <br />� .^_;+97" <br />