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�.....,_ <br />I i "T-� -lT^ ,.^"^- '.'{'?u , : jT: : },-_-; 1 <br />.�' ....1� . <br />�� <br />,_', __ � i, llw:._'�':.. y. � ';'p:�-.�Q. <br />Sewer Applicat <br />?�701 <br />� � - <br />,: _ <br />�� <br />ion:and:P�rmit, ;: ; <br />- - �_. <br />- � _ �. <br />, :_. _. <br />DATE �-'�-y� <br />Service Address � a i e 1:1 ST SS SE _ <br />BIIIIngAddress 3901 HOYT Ave <br />Clly, Stete, Zip F.VEAF.TT NA 98201 _ <br />Owner EVF.RF:TT CLTNIC <br />Connectl0n by KIRTT.F.Y CO1.E <br />Address <br />Phone _ <br />Legel Descriptlon: <br />Lot <br />Block <br />Plat <br />Unplatted Description: <br />Type ol Permit hk:a COrrtF.CTIoh <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424•5555 46-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />,4-:.c�=���z--,--.•-.- -.,r-------�---- <br />CHART NO. -- <br />TO POSTING_ �i-�9� <br />PermitFee $ »�a�' <br />Connectlon Charge <br />Trunk <br />Laterel <br />Tolal Connection Charge <br />Utility Development Fee <br />Weter <br />S9W6f <br />Total Development Fee <br />Sewer Bond Dlstrict _ <br />Abutting Lot Line <br />N, S, E, W — <br />Approved By <br />Issued By Mti <br />Customer Signature <br />$ <br />$ <br />$ <br />-�- <br />$ VSS.fi1 <br />$ 4G2A.44 <br />$ 63RG.06 <br />l ' <br />Inapectlon <br />Date Inspected <br />INSPECTION <br />' 297C� ` <br />n. <br />