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<br /> I "" CHART NO. �
<br /> � ,_, �
<br /> � :
<br /> I �1 �
<br /> C
<br /> :�::
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<br /> C' I
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<br /> f.� C� .:1 ll � �
<br /> i L, q , i t 1 O L7 � CJ G
<br /> pp ' `: ,: , � , �; ., :;. ' � ;�� �, ro �rsri►uc �a _ j
<br /> Sewer A lica�io� and= P���n v�. ;
<br /> �; o � �� - < « " � ���,, �-
<br /> �-• o �5 i� cS w � c �._ ._� . - o . i+ �: �'
<br /> 2 �2 ? 5 �, - :�_, ;� � �' �. � >: _ti �� �z � ,� ;
<br /> Q fi' .-+ L1
<br /> DATE _ � %Z ��3 ,
<br /> Service Address ��0� � L,Ll,�7'�'/i �( !i / Utiliry Account No. i
<br /> Billing Address 14410 BBL-RF.D RD ;
<br /> City, State, Zip BELLEWE Wa 98007 _ permit Fee � 70.00 '
<br /> IOwner COLONY CRAF'r Connectfon Charge '
<br /> Connection by a Cit�� Trunk
<br /> IAddress Lateral g �
<br /> I Total Connection Charge $
<br /> -0- i
<br /> IPhone Utility Development Fee j
<br /> � Legal Description: Water $ 224.00 i
<br /> Lot _ �
<br /> � Sewer $ ,'
<br /> I Block Total Development Fee $ �'4•00
<br /> � Plat NANABRCR7K llIV II
<br /> Unplatted Descript(on: �
<br /> Sewer Bond District __ nr m �
<br /> �
<br /> _ Abutting Lot Line �
<br /> �
<br /> �
<br /> i
<br /> rv, s, e, w n. ,
<br /> Type of Permit N�'� CO!tNECTION I
<br /> Approved By
<br /> Remarks - �
<br /> Issued By -%�� �
<br /> ' I
<br /> Customer Sfgnature - � �'
<br /> � i
<br /> I IMPORTANT! ,. ;
<br /> i
<br /> CALL 1-800-424-5555 48-FIOURS ',
<br /> PRIOR TO DIGGING '
<br /> � Inspectfon By CrJ��� �,,u.., I
<br /> CALL 259-8810 FOR IN„PECTION
<br /> Date Inspected �•- � 1�
<br /> I SEE SKETCH A7TACHED ,
<br /> INSPECTION ^ �'��Z?
<br /> I
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