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2007, 04-03 Permit App: 07001753 Sewer15094774715 Spokane Utilities 03/02/2007 08:44 5098921208 SEP 08 2004 10:4SAM HP LASERJET 3200 LEXINGTON 114549am 03-02-2007 2 /2 PAGE 02/03 p.2 Spoke County Division orUSHitia SEWER CONNECTION PERMIT APPLICATION FORM PLEASE NOTE Ibis t4plioeion tam nee be MAcd am accm.te4l and In is nen a.td sten, w s pent r5 no be imtcd. Sena perms arc .nlid foc 12 moon form tba dnc of nein A cern dpgkeet'wn7 pair iv requited ferny wen patterned Le re from the panic d=hto4a+y. 61 ic+viatc ptombi:,s.d cleaned read: mono rpaerc pen io. RNC 2iOCK RIoct ' pOPTIC IINPORMATION ijstaLth A' CI Temporary Daaaetia.,eAXIMI-rfDal HOMES X X - Adt6ac IDS{ 1ij1749 61'1 ' ' . P4- l ' • MRSTfNOE 00T17RACTOR9 OR PIONS OWNERS PERPOIIII GTBS INSTALIATIONM1ST FIRST coNTACT THE VDU= DIV19MON =IOU P' CMI B81S&1®. SIGN;111REOPUTIUT�S DIVISION. PERSON CONTACTED;.�^'^'�'�� _.3 •t ,o7. Sve tm.erc'0 (main emnba.. a L E x C.I.EQ (na EP. Buirvo ed:l r . t)�L.V ' G2(19 II V,'. Vi V I ISA.. f�T►� /� cr7/Sa:e_beE i+.4>A ?X1 A/k J:m .610w/�• Coerce Maroc c:o_zq MooI mbec _. Ifet3 . DO yt INTERIOR PLUMBING ALTERAT7®NS7 (yee/no) Sitde oac Mad de ivimeGnb tM44kt6� . -- SS 0 comfy 0 Ory ogpoFym vaucy Cementer (dtbfh nal from : Bodnw Address Pbooc /ABB INFORMATION (,/�/,;t—� NomherolIke:Rom a nocedrmro sever / XI 31dohaeb14d a EL ""'•' + fiOAor Volum town won vs leer • Feta i:Papedne lJe.id ender pun l neat • weto.L.ce:n an..lart.Mdv.tglarS IulMYntse emu* (A4 en►dbrMlteig.y.ieSSP. stare eWstpst0hngidpr.sY..Prmk Pen dee bSdgtdd ,atenten oe end* .n in napa.41 rq#4 - • M4dk bikepp`tt®.M/:ntem¢+4 iornebomoolf'p.rPn:itiarSIWaft ms041.11 w.r. (POR SITUATIONS Nor COWARD MOIB, CALL THE 000MTORISON OF UTW2I65ATm4wq , Is wry of the.aotk to be performed is of from the vatic tight at+Wny? 0 Yee 13 No 0 0 Ort /apa rt Vinay APPLICANT SIGNATURE DATE fiXt e NI -Method a Payere= 0 Cash 0 Cheek - 0 Pm G iNbistaCeed 0 Discover Gid' Dam: - Fspilar,. wed Number • Aeithrrsad*sae tans ETniaeeattltid4aadellai sat