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G'�'T'<^�s-^�r+r.n+yx�c+q�zg-�iw,R.;wbP�. �,.,-x w -t -:�. c: <br />, .� .. . . .,. . <br />.trti,: <br />CHART NO. <br />�; <br />�, <br />; T pnsTiN�_ ��-u-�. <br />�� y ` <br />T_ O�� rif.� �.'''_i �Tj� r��,�.. <br />� <br />('C: r'I G . — ti� ^� . ',�� <br />�.7 �-� �^ .> f., p �. . <br />p' ' ' <br />.: .a -. . <br />Sewer Application and� per�tit �= ? . �, <br />�- -� <br />r, � <br />� �? f_� u i-� ia r..l • <br />� C�t f_� ��3" btJ Gl W � <br />M1 O� G G] -? - O i— p 3.'- W <br />O rl � fd J O c+: !'J �1 <br />t- w i11 6i O G_ 7.: :S fj! — _i <br />2 9 3 5 G c�ATe _ nz�T9s <br />Service Address 2431 56th S� SW __ <br />Billing Address Z5517 NE 42nd Pl <br />Ciry, State, ZIP _ Rednond wa ePoss <br />OvYne� Bruce Robbins <br />Connection by _ <br />Address <br />Phone <br />L.e�al Descrfption: <br />Lot 76 <br />Block <br />PIBt Powder M111 Higt,landa tl2 <br />Unplatted Description: <br />Typti of Permit Nev conner.tion <br />Aemarks <br />IMPORTANT! <br />CA�L 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Utility Account No. <br />Fsrmit Fee $ _ <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 Cistr.ct <br />Abutting Lot Lfne <br />N, S, E, W _ <br />Approved By _ <br />Issued By <br />Customer Signature <br />70.00 <br />—0— <br />224.00 <br />224.00 <br />Inspection By ���"�" ��+r�^ <br />Date Inspected _ /� ' � `�3 <br />SEE SKETCIi ATTACHED <br />INSPECTION �'y'.� :7 << <br />ft. <br />