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■ <br />CHART NO. <br />TO POSTING. <br />A�;,i' 'r3 <br />1 M N N <br />Sewer �►p'" licatio erm� <br />5�k <br />011 <br />ik 12/29/93 <br />?. 9 5 6 Ef DATE <br />115 69th St SE <br />Service Address <br />Billing Address <br />1.416 140th Pl SL <br />City, State, Zip <br />Owner ---------- <br />Connection by -- <br />Address <br />Utility Account No. <br />Permit Fee $ _ 70.00 <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />-0- <br />Total Connection Charge $ <br />Phono Utility Development Fee <br />Water <br />Legal Description: <br />6 Sewer <br />Lot <br />Total Development Fee <br />Block <br />Plat <br />Unplatted Description: <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Now connection Approved By <br />Type of Permit _ <br />Issued By <br />Remarks <br />Customer Signature <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />$ 179.00 <br />$ 471.00 <br />650.00 <br />Inspection By / r9 <br />Date Inspected �T <br />SEE SKETCH ATTACHED 2 9 5 3 ° <br />INSPECTION <br />ff. <br />�. <br />