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C� <br />�J1 <br />x <br />4 <br />N <br />Sewer Application <br />? q i S r" DATE <br />1801 wall St <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner <br />Connection by _ <br />Address — <br />Phone <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Farmit <br />Remarks <br />0 <br />arid64/93�Pe,�i�= <br />g9l <br />1516 2nd Ave <br />Seattle WA 98101 <br />Centrum Financial Svcs <br />IMPORTANT! <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 />CHART NO. <br />Tn WTING <br />i <br />i <br />Permit Fee $ _ <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Conrection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />10.00 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />Issued By <br />Customer Signature — <br />CCU a,-? of <br />ofc .o� <br />InspectionBy <br />Date Inspected <br />INSPECTION <br />?920?. <br />pp <br />n <br />w"I <br />