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� CHART NO. _ <br /> evere�t <br /> e � ��� ��� � ,s�e <br /> City of Evarott � $ a � ;u <br /> � � � r. � <br /> O �~i1 .�i � <br /> Sewer Application and Permit �, � � �, J <br /> 26704 `3 �� � � � <br /> N0. DATE r.. zs_ t�e __ <br /> Service Addreu yy� �_.�,o;,��:� Utility Account No. <br /> Billing Address �� Permit Fee +�.,pp __ <br /> City,State, Zip e�rr�te, ta► s�2o� Connection Chargels) _.yyp�pp <br /> Owne► (Mortgagor) a. o�dee w�ili... To2al Fee ,p,�p _ <br /> BillingName i... � Ozdlaana� 11�1-YS� <br /> �wr ooly� �71.00 <br /> Connectfon By <br /> Address Signed_ i, _-+` .7 ' �ti _ <br /> • custome� <br /> �IOIIB iSf��f7R � <br /> DESCRIPTION: Sewer District. � i _ <br /> Lot Block <br /> Plat Monthly Sewer Service <br /> Unplatted Description_ Monthly Sower Constr. <br /> Typa Permit: � ��, ���q h� <br /> Trunk ��p�� <br /> Lateral_ <br /> Remarka: <br /> � Abutting Lot Line <br /> N, S, E, W ft. <br /> � . <br /> Approved By <br /> IMPORTANTI <br /> CALL 1-800d24-656548•HOURS Issued By_ ����� , ;._y�� <br /> PRIOR TO DIGGING <br /> CALL 269A811 FOR INSPECTION � <br /> Inspection 8y <br /> d <br /> Datelnspected <br /> SEE SKETCH ATTACHED N0. 2670� <br /> IN�PECTION <br />