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CHARTNO. ------ — <br /> � �� TO POSTING_.�-a�-93 <br /> D R7 x <br /> y �M Sewer Applicatiori and Permdt <br /> K � <br /> H xl <br /> �H� ? !" ", DATE %ll� i:.; <br /> N 1�-yI <br /> x x r3' lU2i'1 18C Uz .`.,. <br /> �'� o � Utilit Account No. <br /> ,3 b Service Address — 1' <br /> O HC gar.:e <br /> � �p 8illing Address <br /> Lvcrett WA 9+i�G6 permitFee $ �� r <br /> z y � City, State,2ip <br /> � ri y Owner ''OL"' �' ��iO1=Y Connection Charge <br /> g� <br /> G c~n Connection by Trunk $ <br /> ��� �ddress Lateral $ <br /> � �y Total Connection Charge $ <br /> �' Phone Utility Development Fee <br /> � Legal Description: Water $ <br /> � �� Lot Sewer S <br /> Block Total Development Fee $ <br /> __� Pial <br /> I ��' Unplatted Description: — Sewer Bond Dislrict <br /> Abutting Lot Line <br /> � <br /> i ��� N,S� E�W R. <br /> . Type of Permit ��ew connec[Soti ppprcved By <br /> �,r. <br /> ��1�� Remarks Issued By <br /> � <br /> CustomerSignature. ' t� <br /> / <br /> �1-� IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> Inspection By����� �� �� <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected _ <br /> SEE SKETCH ATTACHED <br /> INSPECTION <br />