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�A � <br />F- <br />� <br />�: <br />� <br />y�� Sr3��', �? C���r.; <br />t� :� n�.� �� S r � v� <br />�..' y.,. .n .d •il .n �i� pl <br />J. <br />Sewer Applicat�o� a d� �';rmit <br />���������;� <br />� � � �? o� �1G�93 u{ .., ,.: <br />� 2���� DATE <br />Service Address 132 blet 8t 8{i <br />Billing Addresa »6Q7 195ih Ava NR A'3 <br />City, Stete, Zip Hoodinville WA 98072 <br />Owner unt• foid Cu�tom Elomes Inc <br />Connection by T IiCT//� � S _ <br />Addresa — <br />Phone <br />Legal Description: <br />Lot 1 <br />Blxk <br />Plet <br />Unpletted Descrlptlo�' <br />Type ot Permit <br />Remarks _ <br />Nw conn�ctlon <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•6810 FOR INSPECTION <br />Utillty Account No. <br />Permit Fee $ <br />Connectlon Chargo <br />Trunk <br />Lateral <br />CFlART N0. <br />TO POSIING i � -� <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />a <br />$ <br />70.00 <br />0.'10 <br />$ 179.p0 <br />$ 471.00 <br />a eso.on <br />Sewer Bond Dlstrict <br />Abutling Lot Line <br />N, S, E, W h• <br />Approved By — <br />Issued By nG8 <br />Customer Signature <br />Inspectlon By ��P��'�� <br />Date Inspected ��U � � <br />SEE SKETCH ATTACHED <br />INSPECTION <br />� z9f�� <br />0 <br />