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� <br />� <br />�; <br />� L'1 ':. .:�1 � � 1�, � � �� <br />,� l'� Ct -ai � :F �^� � � C�1 <br />IIl rF rl W v: �f �.O N <br />N' �R <br />Sewer Application ai�d PQrr�� P�-: <br />.._ ��L�r:i _ .J � i:� U <br />�� `] L_. � ��'' x�i C �. �S ' r. <br />1- <br />i�•`��J� -, J�e,',t�:'f�'���;.z�,��'" <br />UATE il—o2—�3 � <br />�ervico Address 21 - Sbt' Pl SE <br />Billingqddress Z44i0 Bel-Ked :ad C20J <br />Clty, StBte, Zip Bell.evue l��A 98007 <br />Owner :.olo�iy Craft <br />Connection oy 0-� C� <br />Address <br />Phone <br />Legal Descriptior: <br />Lot �7 Hunabrook Div ? <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit �uw ccn:icction <br />Remarks _ <br />IMPORTANT! <br />CALL 1-500-424-5555 48-HOURS <br />PRIOR TO DIr,GING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH A7TACHED <br />Utility Account No. <br />CHART NO <br />T(1 PO�TINf _ � - 3� -9 <br />'`'7 <br />�� � <br />O +Y' fi� <br />� '`f 1) <br />:, � <br />{e l� <br />� '• � <br />_� <br />w Cy y <br />c� . <br />� _: �; <br />PermitFee $ 70.0� <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 />:��iwtting Lot Line <br />N, S, E,1M _ <br />Approved By <br />Issued By <br />Customer Signature . <br />FCH <br />� <br />224.00 <br />224.00 <br />Inspection By <<��' n <br />L`ate Inspected � z _ � •`� 3 <br />INSPECTION <br />ft. <br />