2002, 05-28 Permit App: 02004136 Sewer Project Number: 02004136 Inv: 1 !'ipp1ication Date: 5/28/2002 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-CHESTERFIELD 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: 003149 Name: CHESTER FIELD District: F
Parcel Number: 45332.2802 Block: Lot:
SiteAddress: 11113 E 38TH AVE Owner: Name: HUFF,RICHARD
SPOKANE,WA 99206 Address: 11113 E 38TH AVE
Location::SPO SPOKANE,WA 99206
Zoning: UNKN Unknown
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 Released By: � 428
eica.sLoc, a.
Permits:
Sewer Connection Permit
Contractor: SHORT SEPTIC SERVICE INC Firm: SHORT SEPTIC SERVICE INC
Address: 3350 WILLIAMS RD E Phone: (509)639-2393
ALMIRA WA 99103
Item Description Units Unit Desc Fee Amount
SEWER CONNECTION 1 NUMBER OF $85.00
PROCESSING FEE 1 Y OR BLANK $15.00
Permit Total Fees: $100.00
Operator: RMB Printed By: RMB Print Date: 5/28/2002
Project Number: 02004136 Inv: 1 Application Date: 5/28/2002 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Sewer Connection Permit $100.00 $100.00 $0.00 $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: RMB Printed By: RMB Print Date: 5/28/2002