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u <br />WF77 <br />Sewer Application.. and Permit., <br />,. <br />0 DATE 2-5-93 <br />Service Address 1110 84th St SE <br />Billing Address PO Box 333 <br />City, State, Zip Lakewood VA 98259 <br />Owner _1111 r: ndbvrrt <br />Connection by _Madly Const <br />Address 9611 51et Ave NW <br />Mnrysvlllo WA 98270 <br />Phone 659-9586 <br />Legal Description: <br />Lot I of Beverly vlevlands No 2 <br />Block <br />Plat <br />Unplatted Description: <br />Type otPermit Nov 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 9-L1-9s <br />Permit Fee $ n . no <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 />Approved By <br />Issued By <br />Customer Signature <br />$ 270.On <br />$ 450.00 <br />$ 720.00 <br />$ 179.00 <br />$ 471.00 <br />$ _ 650.00 <br />Inspection By <br />Date Inspected �c 919 7 <br />N3PFCTION <br />R. <br />