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---".'���� <br /> .. . ,.,;..,, � <br /> CHART NO. — _ <br /> ; <br /> c''�'Ll( <br /> _ Y� ri"UJill�.`l.� /�� i __ <br /> '{ - <br /> L <br /> � . . . . ' " ' ' � . <br /> � - . ' I 4'� 1"r 1 <br /> � � . ..l .'1. <br /> Sewer Application and Permit ;-, ,�, + <br /> � - � <br /> 2 9 i 3 8 DA7� 4/z/v3 <br /> 31G 109th St SE <br /> Service Address . Utlliry Account No. <br /> BIIIing Address — Po Box 755 <br /> Clty, State,Zip Mukilcao NA 98275 permit Fee $ 70.00 <br /> Owner Pacercarm Con.e Connectlon Charge <br /> Connectlon by Trunk $ 330.00 <br /> Address Laterel S <br /> 330.00 <br /> 7otal Connection Cherpe $ <br /> Phona Utllity Development Fee <br /> Legal Deacriptlon: Water a 179.00 <br /> Lut <br /> Z Sewer a_ 471.00 <br /> 650.U0 <br /> Blxk Totai Developrtient f'ee a <br /> Plet SP /24-92 <br /> Unplatted Descdptlon: Sewer Bond Distdct ���-�� �,'����= <br /> Abutting Lot Line <br /> N,S, E,W n' <br /> Type of Permlt Nn+ conscruccion Approved By <br /> cn <br /> Remarka Issued By <br /> Customer Signature � ' � _' � l�`" <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING !� <br /> CALL 25A-8810 FOR INSPECTION Inspectlon By��`�' <br /> Date Inspected <br /> SEE SKETCH ATTACHED <br /> INSPECTION � 9 � � Z <br />