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F3 0 s] <br />jo <br />C H <br />>Hto <br />Ham+ <br />FC f� <br />IHI <br />H xl <br />� M H <br />z <br />R0 <br />OH <br />>H 7 <br />t HH <br />gy <br />C]CCC7ti <br />Cd <br />H t/� <br />HOtn <br />Sewer Application and Permit <br />'DUI <br />. , ' ` DATE Juno 29, 1992 <br />Service Address 3209 Pine St. <br />Billing Address 3002 Wotmore <br />City, State, Zip Avore ; w:;� n^ m <br />Owner City of Fverott <br />Connection by J Horner Contractor Inc <br />Address 9425 let Avo <br />Seattle, WA 98103 <br />Phone 763-4393 <br />Legal Description: <br />Lot 29 F S121 Tnt 30 <br />Block 76.1 <br />Plat 6yorbtt land Co's lot Ad9n <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />CAP -Orr <br />1V11;1•]:ifXki1 <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />HART NO. ----. <br />TO POSTING-, <br />06/29/92 u:37AK 00011114637 l7kk't <br />ft0002o799 <br />SEWER $2. i0 <br />000028Eol <br />SEWR $.Z.50 <br />II0002BS02 <br />00002SS03 <br />Utility Account No. SFWFP $2.50 <br />1i00028eo4 <br />SEWER 52.50 <br />CHECK $12.w <br />Permit Fee $ 2.50 <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 District <br />Abutting Lot Line <br />N, S. E, W ft. <br />Approved By <br />Issued By •T 7,3C4troll <br />Customer Signature A h o <br />i <br />Inspection By <br />Date Inspected ��— <br />SEE SKETCH ATTACHED <br />INSPECTION <br />4 <br />. 2 3 S C 1 <br />rl <br />