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1999, 11-09 Permit App: 99010857 SewerProject Number: 99010857 Inv: 1 Applicatipn THIS IS NOTA PERMIT Penalties will be assessed for commencing work without a permit Date: 11/09/19 Page 1 of 1 Project Information: rF Permit Use: SEWER CONNECTION - SHELLEY LAKE 2ND Setbacks: Front Site Information: Left: Right: Rear: Plat Key: 005977 Name: SHELLEY LAKE SECOND ADDIT Contact: GEORGE H WHITE INC Address: PO BOX 52 C - S - Z LIBERTY LAKE, WA 99109 Phone: (509) 994-2928 District: F Parcel Number: 45242.2304 SiteAddress: 817 S SHELLEY LAKE LN Owner: Name: GEORGE H WHITE INC VERADALE, WA USA 9903 Address: PO BOX 52 Location:: VER LIBERTY LAKE, WA 99109 Zoning: UR -3.5 Urban Residential 3.5 Water District: Area: 10,011 Sq Ft Width: 88 Depth: 140 Right Of Way (ft): 30 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Hold: ❑ Department UTILITIES Comments: Permits: Review Sewer Review Contractor: UNKNOWN Address: UNKNOWN UNKNOWN, WA UNKNOWN Item Description SEWER CONNECTION PROCESSING FEE Payment Summary: Operator: CKF Permit Type Sewer Permit Notes: Sewer Permit Firm: UNKNOWN Phone: (000) 000-0000 Units Unit Desc 1 NUMBER OF 1 Y OR BLANK Permit Total Fees: Fee Amount $85.00 $15.00 $100.00 Printed By: CKF Print Date: 11/09/1999 Fee Amount Invoice Amount Amount Paid Amount Owing $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 $100.00