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0 <br />Sewer Application <br />f.:^ 29680 <br />DATE <br />:< <br />�� �re� 2172 Sumit <br />BqNrp Address sa'a <br />Cfty, State, Zip <br />��� Rob�re E Lipd��y <br />�� �� S�nior S�rvices oi Sno Co <br />�re� 8225 4eh Aw W <br />lSukile�o WA 98275 <br />Phone 290-1250 _ <br />Lepa� oescription: <br />Lot <br />Bbck <br />Plat <br />Unplatted DeacriPdon: <br />Type of Permft �u°°' � na �.c <br />Remarks <br />IMPORTANTI <br />CALL 1-800-4245555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Utility Account No. <br />CHART N0. <br />TO POSTING 3-/ p- � <br />Permit Fee $ 30.00 <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Cherpe <br />UtlIKy Development Fee <br />we�e� <br />Sewer <br />Total DevelopmeM Fee <br />Sewer Bond District _ <br />Abuttinp Lot Une <br />N, S, E, W <br />Approved By <br />Issued By � <br />Cuaromer Sipnature — <br />Z <br />S <br />a <br />a <br />a <br />s <br />Inspectlon By � ''�' �P�`�"�" <br />Datelnspected '�—� �� <br />SEE SKETCH ATTACHED <br />INSPECTION <br />;y� ?.9680 <br />7 <br />