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JWt'6i$wieYBi�a .-v: .e. . ir - <br /> 7 CHART NO. —_ <br /> TO P('S1fNG_ 3o' <br /> 6iB88 �8 8 8 8 <br /> Sewer Application and Per <br /> 1a 0: 1 <br /> 29170 DATE 4/36/97 <br /> 3611 57th St 6'M <br /> Service Address ___— Utility Account No. <br /> Billing Address __14410 Bel-Red Rd <br /> City,State,Zip Bellevue WA 90007 Permit Fee E 70.00 <br /> Owner _ Countryvrood Hooves Connection Charge <br /> Connection by is L—_._ — Trunk $ <br /> Address — Lateral $ — <br /> Total Connection Charge $ 0.00 <br /> Phone _ -- Utility Development Fee <br /> Legal Description: Water $ 334.00 <br /> Lot 33 Sewer $ <br /> Block Total Development Fee E 234.00 <br /> Plat o,r.a.. will ufar.t..e. <br /> Unplatted Description: _ Sewer Bond District <br /> Abutting Lot Line <br /> N.S.E.W h. <br /> Type of Permit Nev coovteetion Approved By <br /> Romarks Issued By •h <br /> _._ Customer Signature <br /> IMPOR'lANTI \ <br /> CALL 1-800.424.5555 48-HOURS <br /> PRIOR TO DIGGING <br /> ` �F'x�tiaw <br /> CALL 259.8810 FOR INSPECTION Inspection By <br /> Dere Inspected <br /> SEE SKETCH ATTACHED <br /> iwshrc110a " 22170 <br />