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��a� <br />Dxlx <br />��y <br />�H� <br />OACO <br />';1 H 'il <br />��Hxz <br />OHC <br />��g <br />�V n <br />t"y� <br />�yH <br />N <br />o�v� <br />�Hfn <br />HOfn <br />Sewer Appllcation and Permi# <br />DATE 3--�-�� <br />ServiceAddress -+�15 virFint� Av�, <br />Billing Address P""�" <br />City, State, Zip }•v�rece un �^2oi <br />Owner Sound Tractnr Co <br />Conneclionby ��-c Co,,truction Co. <br />AddreSS �y03 ltcPheremt Rd <br />i,rlinqton {JA 98223 <br />Phone �57-3133 <br />Legal Desc{iption: <br />Lot <br />Block _ <br />Plat <br />Unplatled Description: <br />TypeafPermit ��lu�rne_�>n <br />Remarks <br />IMPORTANT! <br />CALL 1-500-42R-5555 48-HOURS <br />PRIOR 1'O DIGGING <br />CALL 259-881q FOR INSPECTION <br />SEE SKE7'CH ATTACHED <br />Utility Account No. <br />CHART NO. —_____ _ <br />T(! antT(NG. �-�-9 <br />PermitFee S it;�fitf �o.nn <br />Connection Charge <br />Trunk $ _ <br />Lateral $ <br />Total Conneclion Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Abulting Lol Line <br />N, S, E, W n. <br />Approved By _ <br />IssuedBy_ i'�+ <br />Customer Signature � '� - <br />Inspection By ,��`�� "`"�^----- <br />Date Inspected 3-3'' S � <br />,Nsr� cnoN <br />