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i <br /> � �� : . . � - - <br /> � y y CHART NO. — + <br /> y�I-i I <br /> FC O <br /> Hy�pptl <br /> �M'tl <br /> N <br /> � �� ro PosriNc__ w-► , <br /> OM <br /> �H�g�`y Sewer Application and Permit <br /> � yH <br /> M <br /> g �'H ' � � ' � DATE �;;i?,��„ <br /> ny�y <br /> �� ao� l�i��u. rt :,;, __ � <br /> y Service Address Utility Account No. <br /> O tn 5511 16Eth St SW <br /> Billing Address - <br /> Lynnw�.d WA 98037 7�•'��' � <br /> Clry, State, Zip - _ — Permit Fee E _ <br /> Owner Starlitu GcnsCruction ('nnnectiOnChetgB ' <br /> Connection by Trunk S <br /> Address Laterel 3 -- — II <br /> __ Total Cannectian Cherge S I i <br /> Phone __ U�illty D�evelopmeM Fee i I <br /> LegalDescription: N,ater S 17�'n� .. <br /> � � Lot Sewer a 471.OU <br /> ��� _ <br /> BIocY Total Cevelopment Fee a _5�50.00 <br /> ��' Plet - � <br /> ��� Unplatted Descriptlon: — Sewar 8ori Dletdct � /L' /J� <br /> 1 _ __ �4butting l.ot Llne <br /> ' _ N,S, E,W h• <br /> � Type ol Perml� t7ev cnnnectlon _ qpproved By <br /> �1 Gfl <br /> �� Rema�ks -- Issue,; By— <br /> '� _ _ ____ Custor.�erSlgnaWre_ ___ -- �' - <br /> �� IMPORTANTI <br /> � CALL 1-800•424-5555 48-HOURS <br /> � PRIOR TO DIGGING ; � �-� ' <br /> Inspection B�_�1'c <br /> CALL 259•8810 FOR �NSPECTION � ., � -, � <br /> Date Inspecled _-_—�� — <br /> SEE SKETCH ATTACHED <br /> INSP[C1lUN - <br />