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CHART NO. — _— <br /> � <br /> � �� <br /> Q � H <br /> � � � TO POSTING_�/�� - 3 ' <br /> o� 0 3ewer Applicatioi� and Permit <br /> 'i1 N � <br /> J1 M <br /> � x� ^ 11 '. � DATE . _ ' _ <br /> r�3 r� <br /> O F+ <br /> �� g Service Address '' ` �'�' _—_ ' — Utility Account No. — <br /> n. o <br /> yz y Billing Address <br /> r y � Cl�y,S�a�e,Zip Evc rett �'A 98203 Permil Fee $ _ ",`�" _ <br /> n� �"� A:len.. K.i'qUA � <br /> d v� Owner Connection Charge <br /> ��� Connectionby F`�-elnncP noxing Trunk $ '���'��� <br /> y � y Address — Lateral 6 <br /> � Totai Connection Charge $ —�;c.„n <br /> � Phone Utility Development Fee <br /> ' �� Legal Description: Water $ - -- <br /> Lot _ Sewer $ 47I .�io <br /> � [�71 .00 � <br /> Block Total Development Fee $ <br /> � �� Plat - , <br /> Unplatled DescripUon: _ Sewer Bond District . <br /> i <br /> �� Abutting Lot Line i <br /> -- N,S, E,W fl. I <br /> �+II � Type al Permit •„'`• COt1"c��S1° APProved By �'� <br /> � <br /> I Femarks Issued By � � <br /> ,, <br /> ��� Customer Si3nature�� ' ' � <br /> IMPORTANTI <br /> CALL 1-600-42A-5555 48-HOURS <br /> PRIOR TO DIGGING �"' ,� <br /> CALL 259-8810 FOR INSPECTION Inspec�lon B�E���> ��� -�� <br /> Oate Inspected __��1�L,7 <br /> SEE SKET.^.H ATTACHED <br /> INSPECTI��N � �.� 5 � <br />