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3 <br />CHART NO. - <br /><� <br />8�3 S5 <br />4� <br />p <br />Sewer Application <br />and Permit <br />29790 <br />94 <br />DATE <br />7-I <br />Service Address 4 - 74th St sW <br />Utility Account No. — <br />BIIIingAddress 5703 Wentport Wycd <br />City State Zi Vnncouver BC V7W al <br />Tn DOUING. &-24-'� <br />' p Permit Fee $ 70.n0 <br />Owner Shergsr Lind Corp <br />Connection Charge <br />Connection by A._t;2,:2v4.. Trunk $ <br />Address <br />Phone <br />Legal Description: <br />Lot <br />I <br />Block _ <br />Plat <br />Unplatted Description <br />Type of Permit new connection <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $. <br />Total Development Fee $ _ <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By -- <br />Customer Signature. <br />KH <br />ulr <br />Inspection By be n <br />Date Inspected __/b , <br />as <br />ff. <br />INSPECTION 29790 , , <br />