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I � ' i°+y t,�'.::?��. �C�"�u��`^'vi�'�:�k::'�ir,�T.¢-;4,�S�2;a.,�iZir.`��,,�'?,�:,l��m . . . <br /> I '- ICNART N0. <br /> Y <br /> � f� <br /> � � � rn PosTiN� ��-��� <br /> � <br /> � s� � � s � � � � � � <br /> v�'' wc`. � �'' ;,� ro 4 p � [i <br /> e� .n K «� .� .} <br /> N �w <br /> V1 vJ <br /> Sewer Applica�o� anc� " r ' � <br /> i^,� u � r,px �w ��v <br /> � .. 29561 c � � � � � �` b � � � � � � . <br /> DATE -�-�� _?-�-/y� <br /> � • <br /> Servlce Address j423 2nd Dr SE UtfNty Account No. — <br /> Billing Address 10711 Evergr�en Ney , <br /> Clly,St8t8,Zfp Ever.att S1A 98204 . permit Fee $ T0.00 <br /> p�y�e� L a L auildera Connection Charpe <br /> Connectton by��v s �c�z ,'N a Trunk S <br /> Address Lateral $ <br /> — Total Connection Charge $ '�' <br /> Phone UtilNy Development Fee <br /> Lepal Deacription: Water $ 179.00 <br /> �pt 7 SP 22-92 Broakvood P1 Sewer � a 471.00 <br /> B� Total Development Fee $ 650.00 <br /> Plat <br /> Unplatted Description: _ Sewer Bond DfsMct <br /> Abutting Lot Line <br /> N.S� E�W ft. <br /> ' Type of Permit aev connection Approvsd By <br /> Remarks Issued By M� <br /> Customer Signature <br /> IMPORTANT! <br /> I CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> I GALL 259-8810 FOR INSPECTION <br /> Inspection By ����' /!�<a•+ <br /> , Date Inspected � - � -iy <br /> I <br /> � SEE SKETCH ATTACHED <br /> INSPECTION ,'�� 2 9 6 S 1 <br /> , I <br /> — ------- — -- — _I <br />