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Sewer Applica <br />29447 <br />CHART NO <br />TO POSTING 3-Z2 <br />,.l <br />c?(R,$pES3$ 8 888 <br />{; e• A M N V7 <br />n <br />tion anV Per . <br />DATE 10/12/93 <br />102 Blot St SW <br />Service Address <br />20541 Nit 150th <br />Billing Address <br />Woodinville WA 98072 <br />City, State, Zip —_ <br />Owner <br />Jerry hicks <br />Connection by <br />//,f"0"�js <br />Address <br />Phone <br />Legal Description: <br />I nT <br />Block <br />01M <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />Lot 4 S.P. 1202-35-90 <br />New connection <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 />Utility Account No. <br />Permit Fee $ <br />Conn,3ctlon Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />70.00 <br />-0- <br />$ 179.00 <br />$ 471.01) <br />$ 650.00 <br />Sewer Bond District — <br />Abutting Lot Line <br />N, S. E, W h <br />Approved By <br />Issued By " gb <br />do <br />Customer Signature/ � <br />Inspection By "��F/„u <br />Date Inspected /' '0-y' <br />INSPECTION <br />29447 <br />