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�..._: I\r i(1''c`'""„'_!W`aig:�����..f. : � �j;�" .. <br />� ;�i�r�/��� ,.n <br />� <br />Sewer Applicati <br />" 29643 <br />� �i :.1 1 �'t j . � - t t . <br />.i <br />�;. <br />� ���:�� . _ <br />,;.; <br />:� - <br />�-, ���,,�.� <br />; �, �., � <br />. �,� w ,. . . <br />,, <br />on andPP�rmit y _. � <br />�� <br />:: `��� <br />„ ����,� �:�� <br />� �� LL, ;,'. 't� :', ,:, 4� .� <br />DATE Z%9/94 <br />18 81et St SN <br />Service Address . <br />BllfingAddress ZOSbl Nfi 150[h <br />Clty, State, Zlp Noodinvllle 98G�2 <br />Owner — Jarry liicks <br />Connection by �;�� � r <br />Address <br />Phone <br />� ; • Lepal Desc�Iption: <br />' Lot <br />Block <br />Plat <br />Unplatted Descriptlon: <br />Typ9 of Permit Harcconnaction <br />Remarks <br />IMPORTANTI <br />CALL 1-800-424-55:i5 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />Utllity Account No. <br />Pormit Fee $ <br />Connectlon Charge <br />Trunk <br />�� <br />CHART N0. <br />TO POSTING g--y-9� <br />---�- <br />Leteral <br />Total Connection Cherge <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 Slgnature <br />$ <br />$ <br />a <br />10.00 <br />'� <br />$ 179.00 <br />$ _ 471.00 <br />$ 650.00 <br />Inspection By �� t �.».., <br />Date Inspected � • ���`�y <br />SEE SKETCH ATTACHED <br />INSPECTION <br />gb <br />� x964� <br />n. <br />