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2002, 04-22 Permit App: 02002859 SewerProject Number: 02002859 Inv: 1 Application Date: 4/22/02 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Proiect Information: Permit Use: SEWER CONNECTION - EASTON Contact: SHORT SEPTIC SERVICE INC Address: 3350 WILLIAMS RD E C - S - Z: ALMIRA WA 99103 Setbacks: Front Left: Right: Rear: Phone: (509) 639-2393 Group Name: Site Information: Project Name: Plat Key: 001623 Name: MICHENER'S REPLAT Parcel Number: 45182.0408 Block: Lot: SiteAddress: 1420 N MESA RD SPOKANE, WA 99212 Location:: SPO Zoning: AG Water District: District: Owner: Name: DECKER, ROBERT L Address: 1420 N MESA RD SPOKANE, WA 99212 Hold: ❑ Area: 9,760 Sq Ft Width: 80 Depth: 122 Right Of Way (ft): 60 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Road Obstruction Permits: .t. Contractor: SHORT SEPTIC SERVICE INC Address: 3350 WILLIAMS RD E ALMIRA WA 99103 Item Description SEWER CONNECTION PROCESSING FEE Released By: Sewer Connection Permit Firm: SHORT SEPTIC SERVICE INC Phone: (509) 639-2393 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Operator: JAS Printed By: JAS Permit Total Fees: Fee Amount $85.00 $15.00 $100.00 Print Date: 4/22/02 Project Number: 02002859 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/22/02 Page 2 of 2 Notes: IWAIMMAllev-c11, Payment Summary: _tt- Permit Type Sewer Connection Permit Fee Amount Invoice Amount Amount Paid $0.00 $100.00 $100.00 Amount Owing $100.00 $100.00 $100.00 $0.00 $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 all 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: JAS Printed By: JAS Print Date: 4/22/02