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a*ww <br />888888 8 S 88 <br />♦ M <br />Sewer Application and <br />Wn. <br />2 �? i 77 DATE �/29/97 <br />Service Address . 5901 3rd Dr 0 Utility Account No. <br />Billing Address 237 Elm St <br />CHART NO. <br />TO POSTING <br />City, State, Zip Everett WA 98203 Permit Fee $ <br />Owner _ t H.Connection Charge <br />Connection by :�C Trunk $ <br />Address — Lateral $ <br />Phone <br />Legal Description: <br />Loi <br />Block — <br />Plat <br />UnplaOed Description: <br />Itanabrook Div 3 <br />Type of Permit _ Now connaccion <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development For. $ <br />70.00 <br />0.00 <br />179.00 <br />179.00 <br />MD <br />Sewer Bond District — <br />Abutting Lot Line <br />N, S, E, W fl. <br />Approved By <br />Issued By GB <br />r IY1�� <br />Customer Signature - <br />Inspection By l - a ' r,... - <br />Date Inspected s" -8 -23 <br />SEE SKETCH ATTACHED <br />INSPECTION - 29117 <br />