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CHART NO.M �q"�'S <br /> everetl <br /> e �-��� ��- � <br /> � � 8 z,-� � <br /> Gty of Eva�et <br /> Sewer Applicction and Permit � <br /> No. 23633 DATE � � � '% ;= C, <br /> i <br /> $ervice Address�{L/ �:�11(�.���� n'�� Utility Account No. <br /> , I ,� , L, <br /> Billing Address ` ' � �- ' ' ' ' ` ' - Permit Fee � <br /> City,State, Zip � �-�� � -� -, j � �� ` � / Connection Charge(s) <br /> G , 4: <br /> Owner (Mortgagor) � - �= r , - .< < �� -r Total Fee � <br /> Billing Name I - 1= r , � ,..: i .. , � - <br /> Connection By ' �t <` ( - .:c_ <br /> Address 1 - � ' ' ' • � ' =- Signed <br /> cu:tomer <br /> Phone '='� - = �` "� <br /> DESCRIPTION: Sewer District _ <br /> Lot - = �' � �l- ` Block � '� / Monthdy Sewer Service <br /> Plat '- , � L'i �! �. <br /> Unplatted Description Monthly Sewer Constr. <br /> Tru�k <br /> Type Permit: , � : _ <br /> — Lateral <br /> Remarks: qbutiing Lot Line <br /> , <br /> P O F 1 a o N, S, E, W ft. <br /> u <br /> � <br /> � - 5 � = <br /> �U� Apprcved By <br /> . ./ r � '. � r� �•� �___� <br /> Citv Enginea <br /> Issued By `-" � � <br /> Inspection By <br /> Date I nspected �� <br /> SEE SKETCH ATTACHED ND• 23633 <br /> INSPECTION <br />