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r <br />o o' g o <br />Sewer Applicatiort aid : r <br />?_ 9 7 7 4 DATE <br />Service Address 3920 Rucker Ave AABCO <br />Billing Address 4815 135th Pl NE <br />City, State, Zip Marvnvilla BA 98270 <br />Owner llarbhajan Mangat <br />Connection by Dream Construction <br />Address PO Box 693 <br />Snohomish 98290 <br />Phone 252-0136 <br />Legal Description: <br />Lot 60 & 61 <br />Block 005 <br />Plat Smyth Land 2nd Addn <br />Unplatted Description: <br />Type of Permit new connection <br />Remarks <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 Jl1ai 0_3 1996 <br />Permit Fee $ 70.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Approved By <br />Issued By <br />Customer Signature <br />$ 231.o5 <br />$ 74C.95 <br />$ 1022.00 <br />n. <br />Inspection By <br />Date Inspected 9-16 'iy <br />SEE SKETCH ATTACHED <br />INSPECTION '2 a 7 7'; <br />