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.� Py ... . ..,.,__ »-. . . �} :.u:'... . _ � n.p� , ... .. .. .. .s� <br />� <br />� � <br />r ���� �� <br />i�, oc-.:o- dm <br />�, � '" ..' � .n i <br />- .i . <br />Sewer Applica#io� a�c�;P.ermit <br />�+ �.�'. (��y. �.: o � � <br />CJ O �+ u� J� {.1 S <br />? :Y � L� 4 - Ul f� <br />' 29425 �DATE 9/21/93 <br />�eoo sVo:gr�ea uy <br />Service Address Ufility Account No. <br />Billing Address $°6Q <br />City, Slate, Zip �erstt 98203 <br />Owner &evord .Teeo Enxle <br />Connectfon by <br />Address <br />Phone <br />Legal Description: <br />Lol <br />Block <br />Plat <br />Unplalted Description� <br />Type ol Permit Alteration _ <br />Remarks <br />IMPORTANTI <br />CALL 1-800•424•5555 46-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8910 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />NO. <br />Permit Fee $ <br />Connectlon Charge <br />Trunk $ <br />Lateral $ <br />Total Connecqon Charge $ <br />Ulility Development Fee <br />water S <br />Sewer $ <br />Total Devalopment Fee $ <br />Sewer Bond Disirict _— <br />Abufling Lot Une <br />N, S, E, W <br />Approved By <br />Issued By <br />CustomerSignaNre� �' �-�:--- <br />30.00 <br />n. <br />�%��l �n�yOu1� I <br />� ��� � Tr� <br />/AN�� �� (� �7P��r5 <br />V" � � <br />Inspectlon By `�" <br />Date Inspected "�/ � <br />INSPECTION <br />