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��� <br />o�x <br />�HW <br />K�n <br />H x7 <br />�fAH <br />[i70�H <br />��g <br />� Y (] <br />C+y� <br />�NH <br />N <br />n�y <br />�O� <br />� <br />i <br />I �� <br />� �� <br />' Sewer Appiication and Permit <br />CHART NO. - <br />Ttl p�cTit�� S "= <br />� � 7� i�5 � DATE �,/��/�-� � <br />� 4y%�0 Vieta P1 <br />, Service Address Utiliry Account No. <br />Billing Address Sa�� <br />, Ciry, State, Zip �-�erett SiA 4a�u3 permit Fee $ <br />Ow�ier Pnnuls J 2ohineon Connection Charge <br />, Cannectionby �.oct co,ecructim� Trunk $ <br />Address 7403 AtcPhoreon Rd Laleral $ <br />� Arlinscon Mn 9G223 Totai Connection Charge $ <br />Phone Utility Development Fee <br />Legal Description: Water $ <br />Lot Sewer $ <br />' Block Total Development Fee $ <br />Plat <br />Unplatted Description: Sewer Bond District ' <br />Type of Permit ����_ <br />Rert12�kS All o[het feeF wuveS per <br />i.ir{; t;rooi:e 4/?2/93 <br />IMPORTANT! <br />CALL 1-600-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting Lot Line <br />N g E, W fl. I <br />Approved By <br />rh <br />Issued By i <br />Customer SignaWre ��`� � 1�-- � <br />Inspection By ����'�� <br />Date Inspected �'�''> > <br />INSPECTION <br />.'��i J'J <br />L- <br />