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CHART NO. <br /> T TO POfT11NG__j_ <br /> ` � aas � s s asa <br /> �+ M <br /> Sewer Application ancoTer i $ <br /> DATE 5-4-93 <br /> Service Address 2613 57th St SW <br /> Utility Account No. _ <br /> Billing Address 14410 feel-Red Rd 6200 — <br /> City, State, Zip Bellevue WA 48007 <br /> Permit Fee $ <br /> Owner Countrywood flomen <br /> Connection Charge <br /> Connection by <br /> Trunk $ <br /> Address <br /> Lateral $ <br /> Total Connection Charge $ —"— <br /> Phone 644-2.323 <br /> Utility Development Fee <br /> Legal Description: <br /> Water $ 224.00 <br /> Lot 41 of Powder M111 Highland Div 11 <br /> Block Sewer $ — <br /> Plat Total Development Fee $ 224.00 <br /> Unplatted Description: <br /> Sewer Bond District <br /> Abutting Lot Line <br /> Type of Permit New connection <br /> Approved By <br /> Remarks <br /> Issued By <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1-900-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection& A zo c E e <br /> Date Inspected <br /> SEE SKETCH ATTACHED <br /> INSPECTION o <br />