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51[�E SEi�/ER PE[�llvllT <br />�BLV�R lAKE V�lATER DISTRIGT <br />�� 2210 -184nd St. S.E. <br />Ererett, Weahington 98208 <br />83T�38Q <br />Q04�°� <br />The undersigned Uwner hereby makes application for o sewer connection ro sevver rrains o; the District; <br />for property described as folfovrs: <br />Legai Desc�iF�tion: <br />i � 7 <br />1 i ,' � __ _ <br />,�� � <br />� , ,_; ,. _ . _ <br />. <br />Address: _ � � c <br />. i - J <br />� ) <br />. , <br />;;_` <br />, I �, � �, —, - � ; ; �= •,c , : , '�; <br />_ <br />...�..:. •�.,... .....-•-• .. .................... .......:...�---•••.•_•_••..........� ., <br />� <br />. <br />,� , � ` �F <br />� � ., <br />""•'k„� .............f.-"...._...."'••"'............................_....._.v`.1 \ <br />, �, <br />; � . -. . . 7 � ; _.. . <br />.�� Cost ..==:..1..'.:�.c..-.�.,.1_✓ .................................................. <br />, `. <br />'fhe Owner hereby agrees to be bound hy all <br />rules and regulotions, now In force or as here- <br />inafter a�ended, of.the Sewer Disfrict. <br />i I <br />...../L/f - -•.....---._ t_.rL.1..C� ................................. <br />Q��ners »gnature <br />?• ' <br />....------ ......................•- •-••---.........--_••- <br />..._....""'""""'" ..............._"..................... <br />Oovner's AAai;ing Addre-s <br />......................................... .................... <br />----• ................ ........................................ <br />9i(ling Address <br />� <br />Contractor....................•....--•---........_.................._.......----......�.........t�cense No...-----••-_..._....._._..._...........__.._........... <br />Aft�r i�7stollotion, the system sho�l be 6nspecterJ by a represantutive of the I�istiiet before cevering. The prop-' <br />erty nwrer shal! be responsible for ail aperutions, maintenonce ond rep:ifr ef the side sewer. <br />i / ,- , ' � _- � <br />; _,� i,i� _ � ._._•--Date:........,... 1 / <br />, , �... � t 't , <br />Perroit issued by:�... �..=•••••s....:--••.:•=-/....:..:.:..�.L............• ............................. ru--•- �•� --•-............... <br />, <br />, <br />_� ...__y_____W� �._.._._. _ _�.._.__._.1 .::.._�_._.�� _.._�_:._._._�:._�_��_ -_;___,_ __....�._:_ __._v.:.. ...._ �_-�._. <br />