2002, 05-21 Permit App: 02003935 SewerProject Number: 02003935 Inv: 1
,Application
Date: 5/21/02 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: SEWER CONNECTION - SOUTH PONDEROSA
Setbacks: Front
Left: Right: Rear:
Site Information:
a4, rrx.w"an`.'.s':� b:"^NWggi➢�.', � f. S'.c'=-'y+l"�%t'!N I''A,"N?.�G' ,.
Plat Key: 001743 Name: MYRON ESTATES NO 8
Parcel Number: 44042.1907 Block:
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Contact: SHORT SEPTIC SERVICE INC
Address: 3350 WILLIAMS RD E
C - S Z: ALMIRA WA 99103
Phone: (509) 639-2393
Group Name:
Project Name:
I . A tf . _.O .I.3 -. r T.A rlf
District: D
Lot:
SiteAddress: 5019 S MARBLE CT Owner: Name: SLATER, MARK
GREENACRES, WA 99016 Address: 5019 S MARBLE CT
Location:: SPO GREENACRES, WA 99016
Zoning: UR3.5
Water District:
Hold: ❑
Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: „,;,
Review
Road Obstruction
02- LOLa3
Permits: ,.�„m<;
Contractor: SHORT SEPTIC SERVICE INC
Address: 3350 WILLIAMS RD E
ALMIRA WA 99103
Item Description
SEWER CONNECTION
PROCESSING FEE
1 Released B
Sewer Connection Permit
Firm: SHORT SEPTIC SERVICE INC
Phone: (509) 639-2393
Units Unit Desc
1 NUMBER OF
I Y OR BLANK
Operator: CKF Printed By: CKF
Permit Total Fees:
Fee Amount
$85.00
$15.00
$100.00
Print Date: 5/21/02
Project Number: 02003935 Inv: I
Application
THIS IS NOT -A PERMIT
� y
Penalties will be assessed for commencing work without a permit
Date: 5/21/02 Page 2 of 2
Notes:
Payment Summary:,,
Permit Type
Sewer Connection Permit
Fee Amount Invoice Amount
$100.00
$100.00
$100.00
$100.00
Amount Paid
$0.00
$0.00
Amount Owing
$100.00
$100.00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that alt provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be contrued to be a permit for, or an approval of, any violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: CKF Printed By: CKF Print Date: 5/21/02