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CHART NO. _ <br /> i <br /> I <br /> TO PQSTI!' ' <br /> �sss � s s s ss <br /> N <br /> Sewer Application and Permit; _ ,�, , <br /> 2 9 5 x 5 DATE, 12/13/93 <br /> Service Addiess _ 125 59th Y'1 till -- Utility Account No. <br /> Billing Address __ 237 Slat St <br /> City, State, Zip Everr.tt kA 95203 Permit Fee $ ti4.�4 <br /> Owner _ c•.�ct Horwa — Connection Charge <br /> Connection by Trunk $ <br /> Address —__—_ Lateral $ <br /> Total Connection Charge $ <br /> Phone <br /> Utility Development Fee <br /> Legal Description: Water $ 171). <br /> Lot _ Lat 60 Umnahrnnk My 6 Sewer $ - <br /> Block —_—_ Total Development Fee $ <br /> Plat <br /> Unplatted Description: _ Sewer Bond L'istrict ULID B1 � <br /> Atutting Lot Line <br /> IJ, S, E, IN K. <br /> Type of Permit �t1_: - _— — Approved By <br /> Remarks _ Issued By rh <br /> — Customer Signature <br /> MPORTANTI <br /> CALL 1-800-424-5555 46-HOURS <br /> PRIOR TO DIGGING <br /> �' <br /> CALL 259-8813 FOR INSPECTION Inspection By Z8. '/x <br /> Date Inspected x4-Ptivwn <br /> SEE SKETCH ATTACHED <br /> INSPECTION :'. 29559 <br />