17520 76TH AVE W.PDFIIIIIIIIIIII
6217
17520 76TH AVE W
STREET ADDRESS FILE
CITY OF EDMONDS BARBARA FAHEY
MAYOR
7110-210TH ST.S.W. - EDMONDS, WA 98026 - (206) 771-0235 - FAX (206) 744-6057
COMMUNITY SERVI.dE'S DEPARTMENT - PUBLIC WORKS DIVISION
��St. 189�j
January 30, 1996
Joan Epting
17520 - 76th Ave. W.
Edmonds, WA 98026
Dear Resident:
I have reviewed your account and will allow a credit in accordance with our City policy.
The policy'states that the customer will be billed at the retail rate based upon the average
water consumption for the same period during the previous year. In addition, the excess
water lost from the leak will be billed to customer at the City's wholesale rate with a 15%
surcharge added for administrative cost. Only one leak credit will be granted in any three
year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility Billing Clerk, at 771-0241.
Sincerely,
Ron Holland
Water/Sewer Supervisor
RH/lk
cc: Ilene Larson
Utility Billing Clerk
I
wordata\water\credit96\#315300
0 lni:orporoted August 11, 1890 *
Sister Cities International — Hekinan, Japan
.4 �� �0
OEPT
City of Edmonda
Pubtic Woths Divkvion
Ckvic CenteA
Edmovd,Wash
Few Sivo:
Joan Epting
i7520 76-th ave W.
Edmondo, 98026
d
On Decemben 28, 1995
WS Weve notkIled
bQ aoov
acoantmcnt
tvat out
wctel conoumptzM had
)UMP way UP Ord
InO7 we
M"qvt Ane
a poolible
wa;cv AM. ThaqA you twi Utting uz know. Wo -ai2vd o alwaven oad
&ad them cowe nuz and oeteimine we pnovkem. A! it rumnea out wc
in lead hqd a majoh PAobtsm wt;q 000 walel 00 v0kcc P ine
the youse to the, TOM on the ztxeet. 46ze4 nevenal Diaz on kepa0r-
jinaUy had the wo1k compteted on var 15. Hcrozed 1 a ; COPY ot
6ituaclon tre AQ.
the ispoin bitt. It 16 oui qope tha.t Oalea Oq Me
of Edmondo might aveiage out vu, pievioun usage and chan-ge nz WCOW-
ing, on out next!bit4ing 6tatement. Yous ccqnideaazion woutd me
9seatEy appmeckatyd az tMe amount 06 zhe 4epnlA had a vemy Sevene
AmpCct on 0"4 60'ianczak tituation. Thane you once ogain 6ot ate4ting
U6 to AhkA jit"CA,a ;o 1hat we coqjd pet it tixea bc1ove 2CUIAM,
gavot namage 7c ou, nozymposs ya-id az v et- ao oat own-
tD t
(206) 488-2100 - (206) 745-2100 JOB NO.
UNITEDMonroe (360) 794-9500
Everett (206) 337-1200
PLUMBING EMERGENCY SERVICE
17625 130th Ave. N.E. #102 24-HOUR
TO SERVE YOU BETTER =
0 Woodinville, WA 98072 2-Way Radio Dispatched
BILLING NAME PHONE
JOB NAME
CUSTOMER P.O.
BILLING ADDRESS
JOB ADDRESS
------ JOB PHONE
DE CRIPTION OF PROBLEM
OTS. EACH AMOUNT
G
\Z
CHARGE CASH BANK CARD
L-A �HECK
The labor service charge on this invoice for which you are charged is
warranted thirty days. If the fault should recur within that time no labor
charge will be made (if we are notified immediately upon recurrence).
f
No warranty or work will commence until payment is received in ull. No X — — — — — — -
warranty on work where water pressure is in excess of 80 lbs. �e authorized e above sled par to be installed and the
G A
or P,
All bills due 10 days after date of invoice: 1.5% per month or $1.00 ��b led
whichever is greater plus all reasonable collection fees (Attorney and or SIGNATURE (I hereby acknowledge the satisfa ompletion of the above I
court fees) on unpaid balance after 10 days from invoice date. i described work.)
[R REG. 8:00 AM to 5:00 PM MON-FRI TIME 5:00 PM to 10:60 PM MON-FRI 1 DOUBLE SUNDAYS. HOLIDAYS. HOLIDAY WEEKENDS
A TIME 8:00 to NOON SATURDAY & NOON to 10:00,PM SATURDAY 1 TIME [_
j and 10:00 PM to 6:00 AM DAILY
T NOTRAVELTIME HALF 6:00 AM to 8:00 AM MON-SAT plus TRAVEL TIME ONE WAY
E plus TRAVEL TIME ONE WAY.
CABLE FEE 4.00 60078.00 DATE PLUMBER TOTAL c
RENTAL
PERMIT
QUOTE PRICE
TOTAL MATERIAL
IT
OTAL LABOR & SERVICE
TAX TRAVELTIME I TIME TRAVELTIME TIME TRAVEL TIME TIME
LEAVE ON LEAVE ON LEAVE ON
IN ACCTREC.1 POSTED 30
TOTAL AnHIVI! OF ARRIVE OFF ARRIVE OFF
!)01 �73 1 ,
(1: 1 1
77--y
T
APPLICAT1614��-.,
o,
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w47
s
monds;`
Tha'71�0 ),om it'd
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NEW CONSTRUCTION REPAIRS E] LID NO. ASMT.
. ............... .
E.:_ Z WE.
--------- CONTRACTOR ..........................
?77) TF
-Z -------------------------------------------------------- PERMIT NQ
---------------------------------- ------------ ------- ------------------- w
r'j6.9_ADDRESS --A LEG'AL DESCRIPTION: LOT N — - -------------- _T BLOCK NO.
N U E \NEST nSEE t�,V twc�AEO
----------------------------------------------------------------------------------- -------------------- ------ X f
..................................................................................................... ----------------------- ......
NAME OF ADDITION -------------------------------- --------------------------------------------------------------
.............. 44....
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kin
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CITY OF EDMONDS - SIDE SEWER PERMIT
WATEM-SEWER DEP"ThIENT
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the constructl .
Inspection will be provided within 24 hours after requSt. NO Sat., Sun., or holiday inspectl .0n.)
ADDRESS LOCA12ON OF CONSTRUCTION ............... ...................................................
PROPERTY LEGAL DESCRIPTION ................ ....................................... . ........
...................... . .......................... ........... . ........... .................................................... ................... . .............. ... ... ........................... ................................... . ......
.. . ... . .................. . ................................... OWNER AND/OR BUIELDER__F'�'
..... ..................... . ...... . ...................... . . . ........... ...................... ...........
...... ....
...................
DIRACTORIS NAUKE & ADDRESS ......... i 'LL —L.L L'�� -J. al isla _'.. -A
pffmisslon to granted ----------- - -- - ------------ ig ... for repair and/or conneettm of a A& sewer to the city Sanitary wow
WIn accordance, with City FiAnsonds ordinances.
NTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Omtrgator must be employed to cousWoet
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No, 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City FlngineW$ offim
NOTE No. 3--Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at Property line axid 12 Inches inside property line; minimn grade of 2%. No bends in X0"e
sharper than % will be permitted.
NOTE No. 5—Trenches in street must be water settled and surface of street restored to oriod—I condition. Contractors shall be resPi0tsible for failure due to Imp"er
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than Is provided for In the permit, or to do any work on the main sewer or its appurtenances except to is-
sert the pipe into the wye.
DISAPPROVED E] Date ... ........ --- ------- By-1 ............. ............. By ............... Date ...... . .. ... . .. . ............... By ................
APPROVED Date._
_�$ '? ........ . ..... .. . .............................. . ......................................... . ........ . .
Remarks: ....... . ...... . .................. . ...... . .. . ................... / ........................... ... ........................................ ...... .... .. . ...................................... . ...
.1 ........................ ..................................... . .............................. ........................ ................................. .............................. . .. . .. ................................ .......... . .
tAf BOTH Permit Copies MUST Be Signed By Owner of Mrm. Performing Construction PRIOR To Request For Inspection
--- ---- li�ereby c�ertify that the side sewer installation constructed under this permit
Construction)
r
F
A-t-h alll-g ,e in ordinances of the City of FAmonds.
on ; -
C
talled /in_atrid�an e
DAIDIN- _-_ - - .... . ........... day of... .................................................... . .. . ... 119 ......
Check BEFORE you dig for: Water [], Gas E], Telephone 0, Power E], Sewer 0, Other 0 VV
. ... .... .....
Milo.
Tho City of Edmonds
APPUCATION
for
SME SEWER PERMT
NEW CONSTRUCTION 0 REPAIRS 0
OWNER ............ -IC'1114
...................... .................................... ..................................
ADDRESS........... . ....... Z . ........................
........... -------
/00
EASMENT No . .......... ..............
CONTRACTOR
................................................... ........ .............................. PzRwTNo.
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ......................................
NAME OF ADDITION 00 Aer,'"'C Or t* 5, MWA' 0A/14 e 144 Ir- O'c
............................. ..................................................... . ...........................
tv 4 1-0 14-1 tr4 a X 6 e c 7 -r-b— ^� 5 k 'It a ? flil le"ge- V 16�.
Faildws;'— ccmmeA-Ac;A4 41-+ke c0(z'#%)cfl-
0 ic �t-k - ti, F_ %,, 4 f e �c- -:5� 74ja tA d A., e--,r ti, '6 44', z
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A- e C A..), .4 If
1441 zq E. zs-.71 Weve—e-
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3. z 3,2 Z* c4,e- Re, tA- 0 X
F;*-e e R 7- �00-h
C'- u
Approved:
REMVED
MT 2 11074
DATS....... ................... .................. - BY .............................................. ........... . .. -
^9?0
REET FILENCIS MARK, K.D., F.A.C.S.'
21009 76TH AVE. W.
EDMONDS, WASHINGTON 98020
775-3531 OR
TELEPHONE (206) 1775-0167
RECEIVED
VIL, 1--� 3 19 �q
Dir. Of Public �Works
I L t':" 1"7 5 go *r �f
-20-'7(
July 12, 1979 A VET VJ
City of Edmonds, Engineering Division
250 - 5th Ave.-N.-
Edmonds, Washington 98020
Application for permit to place culvert.
Location: 17520 76th Ave. W. Edmonds, WA 98020
Object: To provide access,to property from 175th Street
Plan: Place 20' of 21-24" cement pipe with gaskets to provide
passage for stream under driveway. East end of culvert should
be 12' west of east property line.
Work to be done by: K.C.Galbraith
19707 Filbert Road
Bothell, WA 98011
Sincerely yours,
Francis Marik, M.D.
17520 - 76th Ave. W.
Edmonds, WA 98020
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RECEIVED
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FAIR CREDIT REPORTING ACT DISCLOSURE
(information From Other Than Consumer Reporting Agency)
August 97' 9 ;5
Rainier National Bank formerly
L C
�bu THE NATIONAL BANK OF COMMERCE of Seattle' Edmondia Branch
Dear Mr. Jakublk
We hereby advise you that your applicationfor credit has been:
A. Rejected
for the following reason. or reasons:
B. D Subjected to an increased charge
1. 9 Information disclosed by you in your credit application to'wit:
income insufficient to handle additional debt.�of $2100.00.
Past due status of present payments.
2. information concerning you Which is contained in our files and obtained from
previous transactions with you.
3. Information obtained from a person other than a consume r reporting agency.*
(See below if this box is checked.)
4. [1 Other reason, specify:
*If box number 3 i s'checked,- p I eased be advised that you have the right to make a written request
of us for the reasons for such adverse action. Upon receipt of such a request we will disclose
the nature of the information. The request must be received within 60 days of your receipt of
this letter. Your request must be in writing and directed to the following address:
Rainier National Bank
THE NATIONAL BANK OF COMMERCE of Seattle
Edmonds
Bra
306 Main Street
Street Address
Edmonds, 98020
City Zip Code
Authorized Signature
FCRA 4151 4-71 �ys istant Cashier
VETERANS ADMINISTRATION
FED BLDG,91S 2ND AV MAY 171 197S
-SEATTLE WA18174-
IN REPLY REFER TO, 21/24
FILE NUMBER-
ROBERT W JAKUBIK Cqv,.28 �006 �132
19426 88TH W R4!JAKUS
EDMONDS WA 98020
YOUR AWARD'OF EAUCATIONAL:ASSISTANCE ALLOWANCE,,11S.CHANGEVAS
FOLLOWS
MONTHLY RATE;...�. ..--EFFECTIVE-. DATE .,"ENVING,,DATE
�0182 00 .4-P01-75: 8-,!22 '75,
THIS AMENDMENT IS MAbE�' -BECAUSE, �OF:.'THE: --DECREASE .'INY�YOUR, TRAINING
TIME@
AT THE,END OF'THE LAST PERIOD�SHOWN ASOVEI�YOURi"�REMAININ6
11
ENTITLEMENT'WILL BE'2,1/2�-MONTHS6
ANY�CHANGE IN THE-NIJMBER:OF YOUR :DEPENDENTS'SHOULD):BE RE -PORTED
To THE -VA IMMEDIATELY SO.'THAT''PROMPT�ADJuSTMENT*:MAY-BE.::MADE*'IN
YOUR -AWARD@
C.,
THIS.CHANGE RESULTED IN AN :OVERPAYMENT OF *31,68L Za*
WE PLAN10 WITHHOLD A'SUFFICIENT AMOUNT`;OF;'THE PAYMENTS,DUE YOU
TO APPLY AGAINST -YOUR DEBT9
IF 7HIS.'PLAN IdILLIRESULT.IN UNDUE'.HARDSHIPI' YOU..,MAY �(ONTACT
THIS OFFICE TO MAKE. -OTHER ACCEPTABLE REPAYMENT'.ARRANGEMtNTSe
C
VETERANS ADMINISTRATION
C),
IMPORTANT —SEE REVERSE FOR PROCEDURAL AND APPELLATE RIGHTS
I>
KEEP THIS LETTER FOR FUTURE REFERENCE
Show veteran's full name, VA file number, and social Security number on all correspondence.
VA rORM
APP 1973
21-8332a-2
J ACHIP1 OfIDERS g pAy V011C
NAVPER3 I57I/5(2.73)/fJAVCOVPT Fo�,,,j 2120 (REV. 3.72) S/fJ 0106-077-7151
ORMIN 410H fincludo facuilon & Zip Co e GPA
CHIEF,OF NAVAL RESERVE, NEW ORLEANS, LA 7 . 01,46 DATE ORDER SERIAL
:.,io. UNIT FTACHEOAI�10 LOCATIC, 26 tUG 75 i 1,10062,171',TOP2049
N
COMMAND —
VP-69 f o1her IIIM' IMRIIIIII"r
6
VF_ 9/NARU, 1411II)BEY ISLANI), WA
ONMY OFFICIAL AE01RESS
PAY GR F;Lnt)--_ UESIGNA I '0FVNFC Trs_i4_
LCDR ROBERT V�- JAKUBIK USNR-R 0-4/09-09-43 1325 1.7-7 34 3402
o, 10426 UTH MST
5—AT—EOF I —RTH__ i;_1111TY CEr_ARANCF����—
EMMINDS, WA 98020
SEC BI 05-15-65
MOB BILLET If 11"
ROPOrt" to TH13 NEAREST, ARMED FORCES ACTIVITY FOR CERTIVICATION for physical Pxnalinwion, including flight 1)11�lsicnl
when active duty for training (ACDL)TRA) involves flying, not more h in 30 days prior to A(:DII*I'RA reporting date. fund
not PhY0l.CBl1Y qualified these orders are cancelled. ACD: 660A1 ASED: 651213
2. NO. DAYS
14. :111EPORT j1hol,!j
t:rfflTk PAY A�
f-1w, L
MIN' HOUT PAY IFOT AUTHORIZE 06 SEP 75 0745
R P ID 17=
E_ ORT To.
C01=1DIII
OFFICER
FFA: P-3 TRANSITION/ANNUA
VP-!26W2722- L CRUISE
A :NAS 'kUtbBEY ISLAn - ENTITLED TO BAQ I'D"
OAM31HARBOR-0, �!A 9 82 78
IF THESE ORDERS Ar,
E. YOR, 14 DAYS, TRAINING ACTIVITY WILL EFFECT DETACHMENT TO ENSURE COMPLETION OF 14 DAYS ACDUTRA
EXCLUSIVE OF TRAVEL 110nm MI)
1PLETION OF ACDUTRA RETUR� TO THE PLACE TO WHICH THE ORDERS ARE ADDRESSED.
3. Failure,to comply W
Fth th�se order,
without prior cancellation
action and/ i 71he I, orders by competent authority rally rego
or administrative action affecting your status in the Navoal Reserve. If in disciplinary
-4. You will be in a duty status for the number of days of ACDUTRAX�rformed plus the e to and from your (ItIly
time necessary to trav
statforf not in excess ofthe allowable constructive time as prescribe in Joint Travel Regulations. While in a duty status you are subjecl
to thoXh.iform Code�f:Mifitary justice.
A
5- Authdrlic7to �trqvol byy commercial transportation Directed:to travel by government conveyance when available
(.;R'p q:,L#.Meal.Tickeia FurOished)
'y a
te
A h
ut 04� d'W tra'VeVat p u
yn ex ense subfect r;
Your
Authorized to travel at your own expense NOT subje(j to
m r, an
Ereimbursement
I —ft 7,� —0s ®rdomw're, wilho t
u QY' you are 1 entitled t
provide -for payo�,troyo r I
ence and quarters. Note: I=f=f=h=Zsf! orders do noi
0 Bllowunces for su
ursoment, and allowances and you do not deal"rNeisto bear this expense the orders tire revoked.
7. [3,,
'.1plic _bppli�,qbl,b) : ired Waiver of Compensation has been executed in accordance with BLJPERSM
;r jj�ij ch if �
Rbq 6
AN.
a CO
PAY ALL" ...... AS FOLLOWS:
DIN NCE
SIGNATURE OF ISSUING OFFICER
176140,5..2231,011.31119 2 000620 2D OP2049 00000OA71500(84
TRAVEL
176140j�`
@2231 021 31119 2 00062
0 2D OP2049 00000OA74500(8.
P. Ill. CTIARMN, E'
PER DIEM
ANNUAL ACID RA
1761405.2 31
2
02.1'31119. 2 00.0620 2D OP2049 00000OA74501(o) F101 YES NO PAY
''C'U: 11 111:1111-ATION 0 L TICKETS F SH 1 11 , GRO( 1PL A I
I i 1: i 1 . ... ... CND MEAL . . .......... .. .. ... " ' " URNI ED
HYSICALLY QUALIFIED FOR ACDUTRA
HYSICALLY EXAMINED AND QUALIFIED FOR
ELEASE
RAINING ACTIVITY FNDORSEMENT
ATE
SIGNATURE.OF MEOICAL OFFICFR
m —E
SIGNATURE OF DIc,, 0,,,,,,,
OVERNMENT QUARTERS AVAILABLE
NMENT MESS AVAILABLE
BEMENT
S MEET FILE
4b 6.
Memo to: John E. Moran
Date: June 5. 1967
Supt. of Public Works 4�
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Property Description: Parcel "B" the following described propertyt
tj
All of the East 271.60 feet of the South 1/2
1/4 of Se n 7 9 T27N
t of for r
of the NE 1/4 o 1/4 of S n 79 T27N, R4E. W.M.;
EXCEPT e a8t 20.00 feet thereof for r
Planning Commission File No. S-10-64
Commonly Known as: 175,2-0 - 76th Avenue West, Owner: E.O. Roesler
Z.F.F. Calculation:
x
($5.50) x (141.29)
Public Works Department Use Only:
) Unit x ($25.00)
141.29 Z. F. F.
777.10 Connection Fee
$ Trunk Charge
$ Permit
T
W�p
UTE10--OFFICE COMMI--NICOTIONS
DATE
TO FROM
FORM ror A
SUBJECT:
I / 7 , 6 1? ' X -2 6 C) "
---- --- - - - - - - -
-----------
----------------
f
-
F
T T
--------
-------
1-177
-7-
ell
14
0
Mw�
0
0
REGARDING: 17520 - 76th Avenue West, '3_300
(address)
R E C 0 R 1) 0 F C 0 N T A C T S
MANE, PHONE NO., &
DATE ADDRESS of . CALLER COMMENTS
5/28/74 Terrace Realty Certified Letter No. 406453 sent
requiring hook-up within 60 days.
7/5/74 Certified Letter No. 406608 sent
requiring response by July 12.
8/8/74 Meter pulled.
10/21/74 Water Specialists obtained pennit
#5070.
10/23/74 Connection completed.
U
ACTION TAKEN
Letter received. Address was not
on list to receive sewer letter.
Due to health situation,, letter
was sent and added to list.
Letter received.
INITIALS
TE
lip
TE
JT
JT
CITY of �.'ED'MbNDS
200 Dayton Street - Edmonds,, Washington 98020 - Telephone (206) 775-2525
Department of Public Works
July 12, 1974
Terrace Realty
.22911 - 56th Avenue West.
Mountlake Terrace, Washington 98036
Dear Sirs:
According.to two previous Certified Letters to'you from this office,
water service to your property located at 17520 - 76th Avenue West, Edmonds
p
was to have been terminated on July 12, 1974. In accordance with the Edmonds
City Code, it is required to connect any property within the City of Edmonds
to the sewer, where it is available.
It is now required that you appear in person at the Public Works
Department, 200.Dayton,Street, Edmonds, or contact Mr. John B. Mitchell,
Water/Sewer Superintendent at 775-2525, extension 226, within two (2)
days after receipt of this letter to make the necessary arrangement for
connection. If no contact is made, your water service wi.11 be tenninated.
Your prompt response will be appreciated, as it is not our desire to
discontinue your water service.
Sincerely,
TY 0 MONDS
tEr&D
i i D ec
ector
JBM: te
ACKNOWLEDGED BY PROPERTY OWNER:
PROPERTY ADDRESS:
MAILING ADDRESS-:,.-,,,-:-,
v. W� -
D AY, E-
ACKNOWLEDGEMENT
0
TO
FORM 41 - LITTLE'S
SUBJECT:
C)
,,JTER-OFFICE COMMUNIOTIONS
OATE 19-74
FROM C)
�wo -a - " 3 3 � 0
C�, PCE_=7K_j V_ kFr) C) C-
�A
+-eD L_A �j
7r-O
1.--t LEE- L,-) 4=-7Q-�
, -1 T-
-SNOHOMISH HEALTH DISTRICT
Court House
Everett, Washington 98201
April 15, 1974
Housing and Urban Development
Property Disposition Branch
Logan Building
Seattle,, Washingt 'Y
on
Dear Sirs:
Regarding an H.U.D. owned house at 17520-76th Ave. W.. Edmonds.
'.7
4,
This agency was notified that an open septic tank, or sump was creating a
hazard at that address. An investigation was made on April 12. confirming
the fact that a health ha-zard does exist and that the sanitary system in
in violation of Snohomish Health District Regulations.
To alleviate the problem the open tank must be pumped dry and filled.with
solid material such as sand or gravel* Furthermore, the plumbing of the house
mutt ' be ' connected with the available sanitary sewer of the Edmonds Sewer Dist -
Viet within 15 days.
Please reply when this repair has been completed.
Yours truly,
David S. Peterson
Environmental Health Specialist I
cc: Charles Bash
DP/sh
- -- ---- --- -I
-e-h a-JZ
d2,�
'd
ve
0 I)p (V
oc
C;
kle
Date: June 5, 1967
Memo to: John E. Moran
Supt. of Public Works
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Property DescriptioV. Parcel '�� of the ollowing descrtb;d roperty:
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All of th,4 East,271,60'�eet of e South 2 o he South 1/2
of the 1/4 of the SE 1/4 of.Se ion 7,.T. N, R4E W.Mo-,'
EXCEPT t e East 20.00 feet thereof or road.
Planning Commissio File No. S-10-64
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Commonly Vnown as: .17520 - 76th.Avenue West 0 er: E.O. Roesler
PR 8-3345
Z.F.F. Calculation:
141.29 Z.F.F.
5.50 x (141.29 $ 777.10 Connection Fee
C�6z,4 i.
Public Works Department Use
, " I I . �1-y_ -,-
Unit x ($25.
$ 0 0 Trunk Charge
$ /0- 00 Permit
10 TOTAL
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1971
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RECEIPT With delivery to addressee only :...
Shows to whom, date and where deliver
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SERVICES ith delivery to addressee oniv
ADDRESSEE ONLY
50d
SPECIAL DELIVERY
;PS Form
Apr. 1971 3800 NO INSURANCE 'COVERAGE OROVIDED (See q �?e side)
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NOT FOR INTERNATIONAL MAIL :-*��%O 0-397-458