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CHART N0. <br /> � � "` I <br /> � everett <br /> � � � _ � i.� ��- � j � � I <br /> � <br /> .. <br /> o � �O � <br /> � H � <br /> � � � City of tvere4t <br /> � � Sewer Applicat;on and P�rmit � <br /> � " ' <br /> �7 <br /> �' � � � I __-_ <br /> Q�( y M N0. 2 v O 9 � DATE _��_'_b.'?---�- -- - - _ <br /> 7 � y . . . . ._- <br /> � ro � � P--- Utilit Account No <br /> � :;ervice Address �Ua---�-��r-y'- Y <br /> N <br /> Billing Address -- <br /> Cily, State,Zip — <br /> Permil Fee S _ _ __ _ . __.___._ <br /> Owner — -- Connection Charge <br /> �,i_ C�� �JPrP �� Trunk `� -- -- --- <br /> Connection try _�_-��� <br /> Address _ Lateral $ -- ---� <br /> Totat Connection Charge $ — --- <br /> Phoi�e _ Utility Development Fee <br /> i�-', Water $ — <br /> Legal Description: <br /> Sewer $ <br /> Lot ----'-- - <br /> 1 �� �lock _. - - lota� Da�ielopmeniFce $ _------------ <br /> ' _' ---------- <br /> Plat ----- ---- — <br /> �� Unpintic�d Descri�tion: - <br /> Sewer Bond Dis�rict _ _ .- ---� ----.---- -�---- <br /> i ��� J__ __ Abutting Lo'.Line <br /> __ N, S, E,W --- -- It. <br /> i�� --- , , _-E�_ APProved By -- _. — <br /> �,�I Type of Parmit __,�1��13_L� <br /> , MiLlcr <br /> Remarks Q�_/fLJ�-�if�L,---�sLZ�1G�_ Issued BY--�-�'��-- ---- <br /> +. ��.. ��j /��v c��d�L��_�___,j , r�,� CustomerSignature__ _--- — <br /> r_ ! <br /> ��.,f� . ��,,+, ..� /2. d . <br /> IMNORTRNTI � <br /> .S• c/c 5�...e .c L. ' / <br /> (� /D U ' � o�!' /H/-/ C✓ .d / / / rv �Y� � <br /> ..��1 CALL1-8d0-424-5555 48•HOUflS <br /> � PRIOR TO DIGGING � <br /> Inepection By��_, - -- -- - <br /> CALL 259-8810 FOR INSPECTION � <br /> Date Inspecled _—_��.�-�— -- <br /> SEE SKETCH ATTACHED N0. 28O'3Z <br /> . C�cTn��,f-.�l :,OI'� <br />