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,. ,,.� � �...,r, ,.. . �„ . �' � HARTNO. ,� k ,. ,� „ , <br /> " ' r`�--�-''^`' ` '�, �, .; � • ., .. ----- .--T--- -r�- <br /> ,. . :a m re . , ---• <br /> � , .�+.�..,� `:: -'�'r i� °�;'.;� <br /> C <br /> I � <br /> , � Q PC�STING��d� <br /> I I � � � � $ � g � � � � ��� <br /> .: <br /> y p O fl U'l � L' li <br /> f:l � � M M 'r � M C] y <br /> .1'1 <br /> , Sewer Application a� Perr��� � � �' � M <br /> , ni o7l�iLzi �' �f'i � z i- � nw' <br /> : i:'. �43 � 2 �6/23 93 � � � � � � ' � <br /> DATE <br /> Service Address 10119 26th Av� SE <br /> Utilfty Account No. <br /> { <br /> Billing Address - 22629 53rd A�a SE <br /> � Ctry, State,Zip _ �r�..» vA vao i Permit Fee $ 70.00 <br /> ' Owner mnil+� �CYllo <br /> ` Connectfon Charge <br /> � ' Connectfon by <br /> i Trunk � <br /> Address Lateral $ <br /> Total Connection Charge $ -n- <br /> I ' Ph°�e Utility Developmant Fee � <br />� ' Lagal Description: Water <br /> Lot 20 S 179.00 <br /> Sewer $ �71.00 <br />''� ` � Block <br /> „ Total Developmdm Fee a 650.00 _ <br /> Plat — ���nhev.r Ct <br /> Unplatted Desc�lption: Sawer Bond District <br /> Abutting Lot Line <br /> N,S, E, W g. <br /> Type of Permit �► coaa�ction <br /> Approved By <br /> Remarks I <br /> Issued By <br /> — customer Signature / f <br /> IMPORTANTI _� <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8B�� FOR INSPECTION Inspection By�� <br /> Date Inspected <br /> SEE SKETCN ATTACHED <br /> INSPi=CTION :'''� 2931 ? <br />