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CHART N0. <br /> everen .Se;,,�� C�fa,,,«�� y'-it�-Bg <br /> e <br /> City oi Everott <br /> Sewer Application cnd Permit <br /> N0. ZBTOZ DATE ry ia �oan <br /> Servics Address � Utility Account No. <br /> Billing Addresa Permit Fee�— <br /> Connection Charge�s)_�� '� - — <br /> �rar-�ww <br /> City,State, Zip <br /> Uwnx (Mortgegor) Total Fee <br /> Billing Name ��1 Otilitp M Qrd. 1171-s5 <br /> v�t�r 11f.00 <br /> Connection By �_ �71'� <br /> 650.0� , <br /> Address Signed_ � - <br /> cwtomer <br /> �1011E <br /> DESCRIPTION: Sewer District_���_ <br /> �pt Block Montl�ly Sewui Service <br /> Pl�t <br /> Unpl�tted Detcription_ Monthly Sewer Constr. <br /> Trunk <br /> Typa Permit: � <br /> Lateral <br /> R��=' Abutting Lot Line <br /> N, S, E. W_ ft. <br /> Approved By <br /> a+ <br /> IMPORTANTI Issund By <br /> CALL 1�00121�666548•HOURS <br /> PRIOR TO DIaGINO <br /> CALL 269�811 FOR IN8PECTION <br /> Inspection By_ <br /> Date 1 nspected ���"� <br /> SEE SKETCH ATTACHED Np, �sTOL <br /> INSP[CTIUN <br />