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p"' '_'""'r"`•�ax:7:kR��.-:. <br />Sewer Appl <br />2Q932 <br />u <br />N <br />�, <br />r. <br />� CI oc p p <br />r � C] C100 '��� q0 <br />[� l^ , <br />fn v O�.,' _' {.j p p.: <br />C ! _ : � C� ` � [ � O � � aii <br />� . .� . :i p <br />icat'ro� �c� �,e�nit C(��-.' <br />\ O ' � ~ � 1 .. G L�1 C'J 1 ,_� [f` <br />y !$ �J M�z �" O_ J�bl y. [f` <br />� Y GJ 3L J iF n W^I S l�' Ir "- � fi: <br />DATE lo/iz/9z <br />ServiceAddress SLll Souad Ave <br />Bflling Address 2529 189th St SS <br />Clty, State, Zfp ��bell uA 98012 <br />p„��� _ Cordon Livoosnn <br />Connection by <br />Address <br />; � <br />� - Phone <br />t - <br />Lepal Description: ' <br />l.ot 3 <br />Bbck <br />Plat Shora Acr�� <br />Unplatted Description: <br />n <br />Type of Permit <br />Remarks _ <br />New conn�ction <br />IMPORTANTI <br />CALL 1-600-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CeALL 2�10 FOR INSPECTION <br />��� •�--� iv-is � s� <br />Utiliry Account No. <br />Permit Fee $ <br />Connection Charge <br />_...... �....__-,. . _ <br />CHART N0. <br />TO POSTING i�-��r 9� <br />�, n <br />�� . <br />C f1. <br />r . �. <br />�_. <br />1 •. <br />U " <br />G <br />'- W <br />� �J <br />T�ank <br />Lateral <br />Total Connection Charye <br />Utiliry Development Fee <br />Water <br />Sewer 1 <br />Total Development Fee <br />Sewer Bond District <br />70.00 <br />$ 270.00 <br />a 450.00 <br />a �so,00 <br />a 22�.00 <br />a 589.00 <br />a 813.00 <br />Abutting Lot Llne <br />N, S, E, W ft. <br />Approved By <br />� ��'CS <br />Issued By / , <br />Customer Sfgneture � %� <br />Inspection By Q- L� �k � <br />Date Inspected �- i 3- � z <br />� <br />SEE SKETCH ATTACHED / <br />� <br />INSPECTIO�J <br />Y <br />`. 2�393? <br />/ <br />