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a <br />r ssg�s� s� <br />Sewer Application argil Pqr. <br />�iS L';�vSz �r-u <br />28 1L7 �`aRRR2L r� 22VMLe =IS <br />DATE 7-30-92 <br />Service Address <br />3732 Rucker Ave <br />Billing Address <br />3732 Rucker Ave <br />City, State, Zip <br />Everett WA 98201 <br />Owner <br />N.J. Goodsell <br />Connection by <br />Address <br />7''. 1.1 <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks meter to be installed for water <br />service from flat rate account <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Utility Account No. <br />CHART NO <br />TO POSTING a-`_�_ <br />Permit Fee $ ---- <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ 82.00 <br />Sewer $ 217.00 <br />Total Development Fee $ 299.00 <br />Sewer Bond District <br />Abutting Lot Line <br />N, S. E, W — <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By _ <br />Date Inspected <br />KB <br />Mli <br />SEE SKETCH ATTACHED <br />:NSPECTION 2 <br />c 27 <br />ft. <br />