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jq y*.:--, :�,'�i � 5r.:7. . <br />3 <br />� � •K i� •yi 9 � — ,4 4 � u i i <br />' ! � t.` � . A U i : 'J <br />M.n .. .. <br />]y �ti . <br />Sewer Applica��on_ands�?er�it" <br />� �, ,., <br />c .. ,.. i � �., _°, ��. q s, ,: � �y N .� <br />2"��A � DATE _ 5/16/v3 -- <br />II2TIL1 6005 4th Dr W <br />Service Address Utility Accour <br />Billing Address =�� &lm St <br />f�G� <br />TO ?OSTING_ �� L�_�„ _ <br />City, State, Zip �'•�acc WA 98303 permit Fee 5_ <br />Owner SeLce Horas Connectlon Charge <br />Connedion by �> � � — Trunk S <br />Address ' Laleral S <br />Phone <br />Legel Descrip�ion: <br />Lot <br />Block -- <br />Plal — <br />Unplatted Desc�iption: <br />CALL 1•800-424•5555 46•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Totnl Connection Charge $ <br />Utilily Developmenl Feo <br />Water $ <br />Sewer $ <br />Total Development Fee S <br />Sewer Bond Districl ---� <br />Abutting Lot Une <br />N� S� E� W tt. <br />Approved By _ <br />gb <br />IcsuedBy ,�� — <br />� � �,; /.� 1!"' <br />Customnr Signawre �.1!: � �' �% � I � � <br />Inspection By `" �"' �"""' <br />Date Inspected �- � � � y � <br />