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Sewer Application and Permit <br />No. 26091. DATE March tie _1047 <br />Se! viao Addresses <br />Billing A,Aress�+ _4 yier— <br />City, State, Zip�p�_WA �g}7— <br />Owner (Mortgagor)B.,,,K <br />Billing Name <br />salne -- <br />Connection By lopmerlt--- <br />Address 3?24 5ere+re- --_ tiynm-nod-- <br />Phone <br />DESCRIPTION: <br />Lot—.— 3 Block <br />Plat <br />Unplatted Description —_— <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-800 424.5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee 39.91 <br />Connection Charge(s) <br />Total Fee <br />Special Utility Fee 1171-45 <br />water 179.00 <br />sewer 471.00 <br />Signed <br />Sewer District__. fi j <br />Monthly oewar <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W 4543TCQtTTMIEt <br />li1D 1I *V0.00 <br />1171-5 S650.00 <br />Approved By <br />At"MAMe - <br />i1".,t10-h (xa0IW41 tttt <br />Issued By <br />lt.W S414.50 <br />(1. $45.00 <br />i f i S'r2.(1U <br />Inspection By �' .M 1I — <br />Date Inspected. <br />kOD(1il`,1v II <br />WATER No.'26091 <br />N0D0261141 <br />INSPECTION SEWR $30.00 <br />U MIT1"I <br />