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CHART N0. <br /> everen <br /> e � <br /> � � � � <br /> City of Evsrott � ,: -; :; <br /> V p r <br /> Sewer Application and Permit � . = �, �; <br /> o- � � � � � <br /> :: � d � � .: <br /> No. 25976 DATE tbw�� 14• 19e6 � <br /> Service Address ��` ��' � Utility Account No._ <br /> Permit Fee_ 2 50 <br /> Billing Address <br /> City,State, Zip Mrr�t' � 98�0� Connection Chargels) — <br /> n„��. reli�,e� Total Fee 2.50 <br /> Owner IMortgegor) J�i�� � '— <br /> Billing Name <br /> traaWs�_ . <br /> Connection By � 1 <br /> ; <br /> •i..�t 980 � :iigned , . - <br /> Addres� 17107 ]rA 11w BC b c�:,o�� <br /> Phone� - <br /> $ewer District <br /> DESCRIPTION: <br /> Lot u Block Monthly Sewer Service <br /> t�let •�' '��� — <br /> Unplatted Description _Monthly Sewer Constr. <br /> Trunk <br /> 1'ypa Permit: qp o!t - Lateral <br /> Remerks: Abutting Lot Line <br /> M, S, E, W ft. <br /> ? /2 -� <br /> Approved By <br /> IMPORTANTI Issued BY w - .._._r <br /> CALL 1�800�424d555 48•HOURS <br /> PRIOR TO DI601NG <br /> CALL 259�8871 FOR INSPECTION <br /> Inspection By <br /> Date I nspected <br /> SEE SKETCH ATTACHED <br /> No. 25876 <br /> INSY[CTION <br />