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g$ <br />8 v38885�8 8 8 88 <br />O S M M <br />Sewer Applicati@nIland <br />2 9 ! 13 ATE <br />Service Address 5905 3rd Dr W <br />Billing Address 237 Elm St <br />City, Stair. Zip Rverott WA 98203 <br />Owner se <br />Connection by <br />Address <br />Phone <br />Legal Description: <br />Lot 21 <br />Block <br />Plat <br />Unplahed Description: <br />Tape of Permit <br />Remarks <br />hanabrook Div 3 <br />New connection <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259.8810 FOR INSPECTION <br />Utility Account No. <br />NO. <br />TO POSTING <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 />70.00 <br />—0- <br />179.00 <br />Sewer Bond District UL7D <br />Abutting Lot Line <br />N, S, E, W fl <br />Approved By <br />Issued By Hb <br />Customer Signature f A NUJ <br />Inspection Byd7 <br />6e z-- <br />Date Inspected C�Y�043 <br />SEE SKETCH ATTACHED <br />WSP" C-1 ON <br />29298 <br />