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CHART N0. — <br /> TO PQSTINr, a �6-Q3 <br /> ��° <br /> ��H Sewer Applicatian and Permit <br /> > Hp� <br /> y <br /> K y� � DATE 7l20/.z <br /> � y � Service Address -'��'�� vir_wcre;c nve Uti!iry Account No. \ ` <br /> z 3514 Brondaay <br /> � y� � Billing Address <br /> H � g City, State,Zip LWeratt wA 98201 Permit Fee $ ��'��� <br /> c�� c� <br /> z �, � Owner Beam Conntruction Inc Conneclion Charge <br /> r H y Connection by Trunk $ ��n��� <br /> � � <br /> b� Address Lateral $ <br /> � � � Tolal Connection Charge $ Z�'�'•�� <br /> zH(n <br /> y o�' 'I Phone Utility Development Fee <br /> � Legal Description: Water $ 224.00 <br /> �r s��.00 <br /> ' Lot Lot 7 Sewer $ <br /> , 81i.GO <br /> �� Block Total Development Fee $ <br /> ��1 p�a� Scuviev (SP 1202-24-85) <br /> II <br /> � Unplatted Description: Sewer Bond District <br /> �, !�' <br /> � Abutling Lot Line <br /> N,S, E,W n. <br /> ��� Ilcr: connection <br /> � Type of Permit Approved By <br /> Remarks Issued By en <br /> 1�' Customer Signature - " � ' ' f <br /> �� <br /> IMPORTANT! <br /> �� <br /> �`� CALL 1-500-424-5555 48•HOURS <br /> PRIOR TO DIGGING <br /> - - �<�r ��._.,._ <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected lZ -� 'L <br /> SEE SKETCH ATTACHED <br /> INSPECTION <br />