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I <br />Sewer Application and Permit <br />29061 DATE 2-5-93 <br />Service Address <br />1102 84th St sr <br />Billing Address <br />PO Bo,. 333 <br />City, State, Zip <br />Lakewood WA 99259 <br />Owner <br />Tim Sandberg <br />Connection by <br />Maddy Const <br />Address <br />9611 51nt Ave NW <br />Marysville WA 98270 <br />Phone 659-9586 <br />Legal Description: <br />Lot VI—ln4id `Jn 2 <br />Block <br />i <br />Plat <br />Unplatted Description: <br />Type ofPermit 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 />Utility ,Account No. <br />CHART NO. <br />�) POSTING z <br />Permit Fee $ 70.,;Q <br />Connection Charge <br />Trunk <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 />$ 450.UD <br />$ 720.00 <br />$ <br />179.00 <br />$ <br />471.00 <br />$ <br />650.00 <br />Bond II <br />Approved By <br />Issued By <br />Customer Signature 'r <br />Inspection B� <br />Date Inspected <br />INSPECTION <br />%'9C 63 <br />P <br />