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1992, 10-16 Permit App: 92008871 SewerOCT 1:3 "92 11: 07AP-1 RON SLS SAN FAX9264306 T I P.1 SEWER/PLUMBING PERMIT APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRESS:- '!�7 i1/0�- CITY/STATFJZIP; _ PARCEL NUMBEP:- — OWNER: �5` y PHONE NUM8ER:� MAILING ADDRESS: (Street) (Citylstate) (Zip) CONTRACTOR: ALWkiS AGTtVE LICENSE NUMBER: ALWAYA.*100P5 PHONE NUMBER: CI,3-?- 85CO -60 MAILING ADDRESS.- - -�-�L %41q_ SPC k+�WPI 99at (Street) (City/state) (Zip) WA DESCRIPTION X FAC H _ -- - ----- - -- - UNIT =AMOUNT X 50.00 = � SEWER CONNECTION PLUMBING At,TERATIONS X 35.00 = SUBTOTAL EQUALS' TOTAL, PEMIT FEF DUE I.s���_�� SIGNATURE St's)%?ne County Department of Buildings West 1303 3vHnue Wjk 99260 (609)456-3675