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N <br /> µ <br /> CHART NO. <br /> n <br /> :g <br /> r- <br /> ssss sss T� i <br /> PASTING � 2 <br /> Sever Application, and � 'r � " <br /> '4 W . <br /> DA TE 1-21-93 <br /> Service Address <br /> 2531 59thst mi �— <br /> 14410 Bl-Red Rd — Utility Account No. <br /> e <br /> Billing Address I770n <br /> City, State, Zip Bellew" NA 98007 <br /> — Permit Fee $ -- ,,�•r; , <br /> Owner Countrywood Nome" ---___ <br /> Connection Chame <br /> Connection by Own"r - G �k/I fn S 7 <br /> �--- <br /> Address Trunk $ <br /> Lateral <br /> Total Connection Charge $ ---- <br /> Phone 644-237.3 <br /> Legal Description: Utility Development Fee <br /> Lot _?nr E'awer Mill Highlands Water $ 179.00 <br /> Block Sec:er $ - <br /> Plat - <br /> Total Developme,,•Fee $ 179.o0 <br /> Unplatted Description: <br /> Sewer Bond District <br /> Abutting Lot Line <br /> Type of Permit New connection N. S. E, W h• ' <br /> Remarks Approved By _ <br /> Issued By _ MI <br /> i <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1.800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8810 FOR INSPECTION Inspection By <br /> Date Inspected ?^" 9.4 <br /> SEE SKETCH ATTACHED <br /> INSPECTION 2 g L 4 5 <br />