1998, 12-07 Permit App: 98012410 SewerSpokane County Division of Utilities
SEWER CONNECTION PERMIT
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APPLICATION FORM
PLEASE NOTE: This application form must be filled out accurately and in its entirety, and signed, or a permit will not be issued.
Also note that sewer permits are valid for 12 months from the date of issuance. No extensions will be granted.
PROJECT INFORMATION
Job address:
, V 9/ 8
City: S O/i.iAIE
Zip: 9„1/,,,,?
Dry Line
Sewer?V)
Parcel number (ifknown):
Owner's name:
y
City/State: Sr-�kH'Ez , GG/r4
Zip: ?y-?/
Phone:
First-time contractors or home -owners performing the installation must first contact the utilities department (in person or via phone _
[456-3604]) before a permit can be issued. 8 K,7 a Ir'' '`"G.. fan -AA i 1
Name of Utilities Division person contacte „t u.t C, -1 et - at $
CONTRACTOR INFO TION
Contractor (company name):
State contractor license number:
Business address:
City/State:
Zip: Phone:
Contact Name:
Phone:
INTERIOR PLUMBING ALTERATIONS? (yesOaci.
Ell out the information in the table below if applicable*
Contractor (if different from above): Phone:
Business Address:
City/State/Zip:
or 1/1 rePe
,i if < ee:4,N:worse:
FEE INFORMATION
Sewer Connection: Number of Buildings / X (times) $100 (per bldg) = $ /40 -
TOTAL FEE
• For a single-family residential unit, one permit is required;
• For a condominium, townhouse, duplex, triplex or fourpl= with separate ownership (as determined by lot lines) separate
address and separate stub, one permit is required per address per stub;
• For a single building duplex, triplex or fourplex with single ownership, one permit is required
• Multiple buildings (apartments, industrial complexes) with single ownership, one permit required per building connecting to
the sewer.
(For situations not coverel herej_call County Division of Utilities ® 456-3604)
APPLICANT SIGNATURE:
Date: /..2/..79 .V
Return to:
Spokane County Duidon ofBxila"rstd er Planning
Wert 1026 Bmadwy Avenue * Spoleane, Warbington 99260
PHONE: (509) 456-3675 * FAX: (509) 324-3198 * TDD: (509) 324-3166
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