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iDx7x <br />9Hr~n <br />Ox0 <br />'{I M 'b <br />y N <br />/H1 HHt0+70 <br />^. Y > H z <br />�CgC] <br />t" r+ H <br />8M <br />ot7y <br />�M <br />ZH(A <br />H O to <br />Cz <br />qmft ANN, <br />U�i <br />ru <br />1 <br />r to g n g <br />a � <br />« M M M p <br />Sewer Application{�••`(�-fpj}�,•M <br />29259 TDATE 6/4/93 <br />Service Address 2931 Rockefeller <br />Billing Address 151E 2nd ave <br />City, State, Zip Pact -le 98101 <br />Owner — <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot <br />Block — <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks — <br />Cap -off <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />1 <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NO. ------- - <br />TO POUING <br />EK <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 />10.00 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W tt' <br />Approved By <br />Issued By <br />Customer Signature, <br />jo <br />Inspection By <br />Date Inspected <br />INSPECTION <br />?925t1 <br />