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:w'"�'C'.l�:Y.i+�r.T�;f;y.��,...-:.ii �`:�`!r-1`wiT�`-�1r.1�7,Ti7.+i..:%�..�C....,.rf�,?��:'.!"q•C.�.wy.�� <br />� <br />�, � N�3o�.5 <br />r <br />C: <br />� <br />" � r,� - .. <br />i i F <br />:�{ ,j <br />t � _, . <br />i. - <br />Sewer Application and Perrr�it <br />] ,.� � � .� <br />.. � �<..3;�_ <br />�� � �.: i� Y.' ... . <br />�: % 9 5 i 8 DATE 1-19-94 <br />SeMCe Addreee 1zZ04 19th Ave SE <br />Bllling Address - <br />City, State, Zip <br />Owner 'dillisn Csrhart <br />Connection by _ <br />Address '-3U00 27t!� Av�� SE <br />9.�th��t1 wA y5otl <br />Phone 4�9-g�37 <br />Legal Descripiion: <br />Lot <br />Block <br />Plet <br />Unplatted Description: <br />Type oi Permit Cap off <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />' SEE SKETCH ATTACHED <br />Utllity Account No. <br />CHART NO. <br />*^ �ntilNf, �o-�s-S�I <br />Permit Fee $ 10.00 <br />Connectlon Charge <br />T�unk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utilit � Development Fee <br />Water $ <br />Sewer $ <br />Total Devetopment Fee $ <br />Sewer Bond Dislrict <br />Abuttin0 Lot Line <br />N, S, E, W — <br />Approved By _ <br />Issued By <br />Customer Slgnature <br />Inspection By <br />Date Inspecte <br />INSPECTION <br />n. <br />, ��574 <br />