Laserfiche WebLink
CHART N0._ /�-I•'� � "K'� <br /> everett ' <br /> ; �J -- ��� �, C�� <br /> , � <br /> Ciry c�f Everen <br /> Enginaering & Community Services <br /> � Se�wer Application and Permit � <br /> � <br /> � N0. � � ' ':' �' I, I DATE / � ; --- <br /> � Service Address J ��� /� ' � � `� ��/; �: �. ' %'�', Utility Accoun; W.: " � <br /> I Billing Address/7 �/7 /� %'> ��� 61�j-.--� permit Fee_�_�_ <br /> I <br /> <-„ . <br /> City, State, Zip ; - 'r ��/�J. '�.r'�_: � Gonnection Ch�rge!;) - Y _ <br /> r✓ <br /> i <br /> i Owner (Mort9agorl� '' �% ��� /�'� �% -%^ , =. Fofil Fec—.�_ -- <br /> i - <br /> � Billing Name �' <br /> i <br /> � Connection By __ �.- <br /> i <br /> Address Signed /� ' � - ' ' � � <br /> i ���� — � /� � Cus�amer ' <br /> Phone_ �' <br /> i <br /> � DESCRfP'�!ON: Sewcr District i/ _ ..--• �� <br /> Lot � Block "< — <br /> j Plat�-� ��% ...I'- _ Monthly Sr.wer Servicc � � _ <br /> :_� <br /> � Unplatted Description _ Monthly Sewer Constr. <br /> ! TYPe Permit: � � "� Trunk / .� �' <br /> L+iteral -�� <br /> ; Remarks: <br /> Abutting�Lot Line <br /> — ,'_N� S, E, W___ �0 ft. <br /> Approved 8y <br /> C�q�E�ngineer <br /> Issued By � _�� <br /> Inspection By�_��G��'-u-t.- -=------- <br /> e __ Datelnspected � �3 _�__ <br /> SEE SKETCH ATTACHED NO. <br /> � , . <br />