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1994, 04-19 Permit App: 94003312 Sewer 33/ SEWER CONNECTION- PERMT APPLICATION FORM 6145 , (1 *THIS APPLICATION FORM MUST BE FILLED OUT ACCURATELY AND IN ITS ENTIRETY All SIGNED OR PERMIT WILL NOT BE ISSUED. (IF KNOWN) JOB ADDRESS:,La4- / i3/o y / & 1 fir. ' n, PARCEL NUMBER: CITY: STATE: ZIP CODE: OWNER NAME: ADDRESS: `/322 Vvi-. CITY: STATE: GJ,. ZIP CODE: 2,296 PHONE NUMBER: 92 Z - 3G 5- 7 PROPERTY OWNER PERFORMING SEWER CONNECTION INSTALLATION? YES NO (CIRCLE O, *IF PROPERTY OWNER INSTALLING SEWER THEY MUST FIRST CONTACT THE UTILITIES DEPARTMENT FOR CONSTRUCTION REQUIREMENTS BEFORE PERMIT IS ISSUED. CONTRACTOR7-13/e7S ADDRESS : CITY: / STATE: ZIP CODE: PHONE NUMBER: STATE CONTRACTORS LICENSE NUMBER: UTILITIES INSTALLERS PERMIT NUMBER: INTERIOR PLUMBING ALTERATIONS? YES NO (CIRCLE ONE) INTERIOR ALTERATION BY: ADDRESS: PHONE NUMBER: CITY: STATE: ZIP CODE: *ONE PERMIT REQUIRED FOR EACH SEPARATE BUILDING, SHOP, GARAGE, ETC. THAT WILL BE CONNECTED TO THE SEWER. SEWER CONNECTION • # OF BUILDINGS I X 50 . 00 = 5 .0c) INTERIOR PLUMBING ALTERATIONS : # OF TOL BUILDINGS35 . 00 PERMIT FEE $ APPLICANT SIGNATURE: DATE: SPOKANE COUNTY DEPARTMENT OF BUILDINGS WEST 1026 BROADWAY AVENUE, SPOKANE, WA. 99260 (509) 456-3675 `S \ r ' liLIN( A SUt5UIVI IUN Ur a 0 SECfiI1 8 � \I,P\ Pio. FD 1/Y RB W/CAP O `, V © �h WELBORN 15043 r `,` IIlAGE\ 2111116„.1/45‘ ``` ° ;EMEN T :�� /% 6'2•N (�1[� J 7 `,, '''44 -at!.O, ‘ - .. �o�oo,! 2 \ 3 j FD 1/2" W/CAP \ • '1 WELBORN :5043 ` O J V/ DRAINAGE EASEMENT 94'`� � N x�`9 j 9 I 1,-6-0, / w ` ; , is •sem • t;L1 a FD 1/Y RB W/C �' , N5O ,, \\ �I ?s'� : WELBORN 15043 i I �` �R : 1 � .'� I\. S O 2 R2 S0 B e ,1 1 ° c3/ G,A E>t1ENT p O N I I • ‘\___--Be Mr:#1 DRIVE _ S 88'38'57 E_ I, Ail <VO O p o 0 I M .;) �••S X25 1 °. 4 224.77 III 1')Z7 5. O o oo �� .c I 1 34919 SF %I N 6"0 I. " 06 - • 2� .77 — NO c0 a P /�► UTILITY -100.00'- -124.7 75..' 1 ?� •�••: QT1 S 1G.Sw ��••.EMEN Ail ....1 � j��` ,o . . \ i . , co 4 10' A © W 5' U U' �`®i 2 ' Sr43 �/ ^..,131. 46 w • C•st • '. EASEMENT9 0 n EASEME.^ F 2 • Gti 70 SE 33479 S 38541 SF _ N .N - 4 N — — — SANE _ • — — 89'12_07' E U - . i ids..II •�,...._ � :•� �� � . •..' L• . 1 2 • 5' UTILITY I � Z •E^ XII- rob, c NN-FD AXLE AND RP's o v _EASEMENT.-�" O . •v P_ ��0 N - : ..68.— I PER ROS BOOK 26 R C■ LAIyF PAGE 93 s6Og �B� r°D. 3 W �ry I. ,- ,� / 4 y)> �• C • • ' '7S �g • 2178 f SF 0. ,� ,,v/ cv g.' Ji/ ,,.; C1 • -Jt " 205.68 In I /8?0 � Z tiao4 4 2IN150�15 �E' R39 �R4�•;��-C17 � 10%3? 110 966 I 18.4 a 0 32775 SF Z X03 �;�s CC 10 UTILIT 5' UTILTIY 1 Z Z II \ _ W Ia. EASEMENT ^' IO I'AIN-'�j Na 'VS I o AGzESMT. Mo ap op 6 JIm /366g. ' of l0 5 . W N o 2178 •F 0 2178 1- .81e; - o I� 9 �T 1 I°I, 2 462 SF i- N • (� / ;S p 21781 SF• \ N UNp"TrEill ti,s �N --!5. {•� 5, N ? Z Di I i 19. 19 6° ' r— Z I I /,40gc�g 1 122.53 .126.4 107.30 4 I07.'i •0`� �L N 88'38'57" W 464.00 C