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everett <br />clty ot Everen <br />�, <br />� <br />s g g$ <br />� M � � <br />f� <br />Sewer Application a�� �;�mit <br />� � �� <br />NO. 2 8 Z F�. DATE �.y ,+, �99i <br />S9rvl�e Address �1 9rtnkruQ Rd <br />Bliling Address g16 9raskiod RA <br />City, State, Zip �v+s+tt Nl� 98Z08 <br />DYV�� fe�lr :f�Y� !At i!�%}l�l <br />Connection by <br />Address <br />Phone <br />Lepal Description: <br />Lot <br />Bbck — <br />Plat _ <br />Unplatted Description: <br />]S]-6�61 <br />Type of Permit �� �� <br />Remarka . •-� +•�— <br />IMPORI,ONT1 <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH A7TACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />CHART NO. <br />sr��- � p��, �q 6/ie/4i <br />Trunk <br />Lateral <br />Total Connectl�n Gharpe <br />Utility Development Fee <br />Water <br />Sewer <br />Totel Development Fee <br />$ <br />3 <br />$ <br />]0.00 <br />Sewer Bond District —__ <br />Aburilnp Lot Line <br />N, S, E, W n. <br />Approved By <br />Issued By * ��*�od _ <br />Cusromer Signature <br />Inspedion By ��' - j �.c <br />Date Inspected ��1 �9� <br />INSPCCTION <br />NO. ZSZGZ <br />