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<br />56�E SE�NER PERlNIIT
<br />SIL1fER LAKE 1AEAT�ER �ISTRICT
<br />2210 - tYtnd SL S.E
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<br />�Q� ��7
<br />EvereH. Waehhglon SE2a8
<br />; -_.s"`,�:. 387-8ff47
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<br />� y The undersigned Owner hereby rnakes application for a sev�er connection to sewer mains of tne Oistrict;
<br />for properry dev_ribed as follows: ,
<br />Legal Qescrip'rion: The Owner hereby ogrees to be bound by e��
<br />rules nd regulotions, now in force ar as here-
<br />;' i ;� dnaft¢ , amended, of the iewer Dfstrict.
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<br />Addre,s: ;, c+ s Signature
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<br />.............•-'"Owneis Mailing Address
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<br />, Cost ....:: .:....:.. .............•---....._...........
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<br />B°;ling Address
<br />. �cense No ....................•----.._......._..•-••-•_-••••_.- '
<br />Contractor.............•---.........._ .._...................•-•••••-_-_•......_._...••••-- ••-
<br />After instollation, the system chali be inspecied by a represen!ctive of the Disfrict 5efore covering. The prop-
<br />erty owner shell be responsible for all operations, rtAinfenonce and repair of the side sewer. _,% ',
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<br />� ' ' ��.��.l.:.-..--� .........................................Date:.......1..._..... �
<br />Permit issued by:.,l..-�.•1••�•-•! ••`•��� -••-
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