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ti <br />S <br />.t <br />Sewer Application r nd I?e a . <br />29314 DATE 6-23-93 <br />Service Address <br />Billing Address <br />City, State, Zip . <br />Owner <br />5915 4TH DR W <br />237 ELM ST <br />EVERETT WA 98203 <br />SELECT IIONES <br />Connection by SC Lc <br />Address <br />Phone 258-15,3 <br />Legal Description: <br />Lot 11 11ANABROOK 3 <br />Block <br />Plat <br />Unplatted Description: <br />Type of Po;mit <br />Remarks <br />NEW CONNECTION <br />IMPOVITiâ–ºNTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk <br />Lateral <br />CHART NO. <br />W <br />TO POSTING "' > 7 .oco <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District NA <br />Abutting Lot Line <br />70.00 <br />$ <br />-0 <br />$ <br />179.00 <br />$ <br />-0 <br />$ <br />179.00 <br />N, S, E, W ft. <br />Approved By <br />NH <br />Issued By <br />Customer Signature <br />Inspection By 6;"' P / ' Aij <br />Date Inspected _/0 -F -1 <br />INSPECTION <br />29314 <br />