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CHART NO. — <br /> T TO POSTING12-2 <br /> �T I <br /> I <br /> rni0 n O � O ( N <br /> Sewer Application and Permit <br /> DATE/ .'S/Z 43 <br /> Service Address /_/nr J S��S,� SL6) Utility Account No. —_ <br /> Billing Address 14410 BEL–RED RD <br /> City, State, Zip BELLEVUE WA 98007 <br /> Permit Fee $ 70.00 <br /> Owner _ COUNTRYWOOD NOML•S Connection Charge <br /> Connection by /�r�t yr Trunk $ I <br /> Address Lateral $ _ <br /> Total Connection Charge $ <br /> Phone U'Aity Development Fee <br /> Legal Description: Water $ 224.00 <br /> Lot f' <br /> Sewer $ <br /> Block Total Development Fee $ 224.00 <br /> Plat POWDERMLL MIGULAND DT'V <br /> Unplatted Description: Sewer Bond District — <br /> Abutting Lot Line <br /> - <br /> Type of Permit NEW CONNECTION <br /> Approved By <br /> Remarks Issued By_ <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING / <br /> CALL 259-8810 FOR INSPECTION Inspection By �"/eJ" <br /> Date Inspected <br /> SLE SKETCH ATTACHED <br /> INSPECTION 29229 <br />