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�.--------- --- - ----- - <br /> _ . <br /> � �°` CHART N0. � <br /> ��'� � 0 POSTING _��3 -�� ���� <br /> .3 � <br /> i:'; ' c5 c � �5 i; �: � <br /> I �'.'. �� .�n «�+ o o � � - <br /> ln .:A �y .y� , <br /> IA <br /> ! Seorver Application and Permit � � � � . N � , �` i <br /> i _ , o � � r � � - <br /> '�.- � �: ou .-� o � . <br /> - ''� (J�l -i X 'L _ � <br /> i, % `.:i ;�3 DATE �/��/�', � <br /> � i <br /> Service Address 1307 38ch St B1dG 2 <br /> Utility Account No. <br /> Billing Address 4023 lO6th St SL _ <br /> City, State, Zip i:vt 98208 Permit Fee $ �c'�� II <br /> ' Owner �intrae Ho�es Inc Connection Charge � <br /> , Connection by Trunk $ ; <br /> , Address Lateral $ <br /> !� Totai Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ <br /> Lot `} <br /> Sewer $ <br /> Biock '�' Total Development Fee $ <br /> Plat — Pridny/s 2nd Addu � <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Type of Permit iieca connection Approved By <br /> Remarks Issued By `t <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HQURS <br /> pRiOR TO DIGGWG / � <br /> � CALL 259-8890 FOR INSPECTION �nspection By- �{'h���h <br /> i <br /> ' Date Inspected –/ 7-5'� <br /> SEE SKETCH ATf'ACHED <br /> INSPECTION . � r� �� ' <br /> .��._�'�'_ ;� <br />