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n� <br /> �� � <br /> CHART NO. --- — <br /> ��� <br /> �. <br /> y TO POSTIPlG_ �-a��_ <br /> ��� Sewer Applicat�on an►d Permit <br /> H �r+ � <br /> �C C� <br /> � H� ��3`% 1 " DATE 8/27/92 <br /> fp H <br /> x lII Glenwnod Ave <br /> Service Address Utiliry Account No. <br /> O �� 10217 19th Ave SE . <br /> � �g Biiling Address — I � <br /> �y � City, State, Zip �erec: :1�� 96208 permit Fee $ 7� �� <br /> zy� i <br /> � H y Owner — iiimalaqn tiomne _____ Connection Charge I <br /> I <br /> � Cy y , Connection by Trunk $ � <br /> � �� Address Lateral S � <br /> H o� Total Conneclion Charge $ � <br /> II Phone Utiliry Development Fee <br /> I Legal Description: Water $ 179.00 <br /> �, ��; _ Sewer $ 471 .00 <br /> ... �I Block Total Develooment Fee $ F5� 0� <br /> � "o <br /> ��' ! Plat <br /> • �.1 I� Unplatted Description: Sewer Bond District <br /> �' ""� Abutting Lot Line <br /> N,S, E,W n' I <br /> ... .� <br /> Type ot Permit Na�: connection Approved By <br /> GS <br /> �"'°' � Remarks Issued By <br /> �.n. r.> <br /> Cuslomer Signalure <br /> 4 <br /> 1 � IINPORTANT! : — � � � <br /> _ � <br /> ..'�.� - „ � - _ n cc :.: <br /> ''� � ' �' ..- � � _ -i _.4'�. b r� � ra �. <br /> � . .n <br /> CALL 1-800 424-5555 48 HOURS ; � L ' <br /> ,,,,�I� ' PRIOR TO DIGGING , �^ , � <br /> ' o , w • ' I�spectiop By , �� /. 4_ <br /> CALL 255=88)0 FOR IMSPECTION � `. '� :� �- `- � > ?� , rc� <br /> Date Inspected _��'� <br /> SEE SKETGH ATTACHED L , ,� � .� <br /> INSPECTION � <br /> i <br /> c <br /> 1� <br />