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r---- -- - <br /> _. ___ _ _ <br /> I CHART NO. - <br /> ; <br /> I <br /> � � � TO POSTING �i-5-qz <br /> � y I <br /> " � � � <br /> K , .. , .�_ , y , , r �r'i 7. , <br /> � � � I ' ( II <br /> � � � � Sewer Application and Permit ����4z,x°i <br /> �:� <br /> .� � �; ,_o,u� � <br /> ',�e n � '; C,i �:;i..'tfi I <br /> � OA i� i�'�,:�.I,li •� ''.:1.�.`1 �� <br /> � y � � � �? � U 7 DATE �—"'—v� - I <br /> a; t' �:�' i <br /> M Fi .'t� <br /> � o v, Service Address 512 G3ch Pi �'�:: Utiliry Account No. <br /> �ii U�e f Y7 � <br /> � � r �� n ` ],";: <br /> ,� y Billing Address 219�2 32tU Ave ': , , <br /> � i � ��, I <br /> N Permit Fee $ 30 �p" ` <br /> City, State,Zip 1;rier wA 9a03G <br /> � � 1 -�, i�_�;i� � <br /> Owner Fciirmont t,oner, ConnectionCharge „ .:,.� : � <br /> Connection by <br /> Ownr.r TrUnk $ ! <br /> Address Lateral $ __--_ i <br /> Total Conr.ection Charge $ 'I <br /> Phone 35b-2435 Utility Development Fee � <br /> Water $ 179.00 i <br /> / -_. LegalDescription: t,71,CO <br /> ( ��� 4 of Biaci;_ Potr:�,t ],enc S2we� $ <br /> � Lot <br /> Total Developmenl Fee $ 650.00 <br /> � 1 B�o�k <br /> �� Plat <br /> I �-�, <br /> Unplatted Descriptlon: Sewer Bond District <br /> Abutting Lot Line <br /> _ ft. <br /> I _�• N'S' E'W <br /> ' Type oi Permit H�w CON�r.CT10t4 Approved By <br /> I ����� � Issued By ,-�, �i . "r_ <br /> I Remarks <br /> . <br /> „"�__-. �___ <br /> I Customer Signature � ` ' . ._ - <br /> \ C , . <br /> J I IMPORTANT! <br /> I _,� � �' ' <br /> ! CALL 1-800-424-5555 48-HOURS <br /> ��� Ii pRIOR TO DIGGING G' � <br /> .��. I i �: . <br /> Inspection By <br /> I CALL 259-8810 FOR INSPECTION ��,_ 1,•y L i <br /> Date Inspected <br /> I I <br /> i I <br /> i SEE SKETCH ATTACHED '�+-� , � c Q � - <br /> INSPECTION `� ' S� ' <br /> I ----- - <br /> - -_ <br /> . ( <br /> � <br /> � <br />