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Sewer Application and Permit <br />DATE _ 1z14/9z _ <br />7815 Grant Dr <br />Service Address — <br />Billing Address — 5806 �/2 3rd Ava 6W <br />Ciry, State, Zip — S�BCClu WA 98107 <br />Owner :.effr€YJ�'•^h <br />Connection by _ <br />Addrees <br />Phone <br />Legal Description: <br />Lot Z <br />Block <br />Plat SP 41-91 <br />Unplatted Descriptlon: <br />New Connection <br />Type of Permit <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />Utility Account No <br />CHART NO. <br />To PosTiNc �,-�-�3 <br />i.i_�� .� . , . M�G.� i�l <br />F'tE:u ��i•� <br />r�K��i :"C,C(1 <br />('l.`I . � '', � �i� <br />,. . � n <br />�;�,�,°��, -:'U,��7 <br />:_,,,�,., ,.., -- <br />' „ , ,1i�. i� <br />I"L�.: , �,:O.:Y� <br />'� j.0.06 <br />Permit Fee $ �'' '; ` � ` ' <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 Disirict <br />Abutting Lot Line <br />N, S, E, W — <br />Approved 8y _ <br />Issued By <br />Customer Signature <br />$ 270.00 <br />$ 450.00 <br />g 720.00 <br />$ 179.00 <br />$ t.n n0 <br />g �smnn <br />II <br />r,s <br />n. <br />`� , ', <br />Inspection 8 � <br />Date Inspecled � D <br />SEE SKETCH ATTACHED � � 9 � � <br />INSPECTION <br />� , <br />