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.7�^TY.:w , ��F v;'..., ..�I,'� -i-c'• »+:.f--;2��, p�..-f'- .' - " - <br /> � . .� �-� .. .,.. .:-. _ .. . . _ . <br /> ..�, . � . . .� ...... .�., <br /> � T-'-` v <br /> .... . . anl : l•. .� . VS;1 .�)j.`IV.. F. :lr .. ,�.Y 1'.�'�:�� . ,. <br /> - CHART NC1. <br /> �= <br /> � <br /> � -, ,�; -_ *^ nnc'fING io -is-y�l <br /> Sewer Application a�d ��ei�r.r�_i� _ I <br /> � �� 3 � u ;z' ;�i � . <br /> Z �S�'8 :.'?' '� 4� ;_ .- :: �:". <br /> DATE 1-19-94 <br /> Service Address 12204 19ch Ave SE Utility Account No. _ � <br /> Billing Address I <br /> City, State,Zip Permit Fee $ _ 10.00 i <br /> Owner '+7illinn G,rhnrc Connection Charge j <br /> Connection by Trunk $ <br /> Address �3000 ?7ch nvc SE Lateral $ <br /> Boti�ell xA 98021 Total Connection Charge $ <br /> Phone 489-R437 Utility Development Fee <br /> Legal Description: Water $ <br /> Lot <br /> Sewer $ <br /> Block Total Development Fee $ <br /> Plat <br /> Unplatted Description: Sewer Bond District I <br /> Abutting Lot Line I <br /> N, S, E,W g, � <br /> TypeofPermit Cup off <br /> Approved By i <br /> Remarks .. Issued By <br /> Customer Signature i <br /> IMPORTANT! i <br /> CALL 1-800-424-5555 48-HOURS I <br /> PRIOR TO DIGGING � <br /> Inspection By � / <br /> I CALL 259-8810 FOR INSPECTION � , <br /> Date Inspected <br /> SE� SiCETCH ATTACFlED <br /> WSPECTION ' ? y �j J$ I <br /> �_ ' <br /> __ — ---- _ I <br />