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I <br /> � <br /> everett - I CHART NO.����_ j <br /> e ,00 S /'r�0 _, ; <br /> - � ; <br /> , <br /> c�cy ot e�aren S �-Z-,� � 7 � � i <br /> Engineering & Community Services ' <br /> Sewer Application and Permit /�'�� � <br /> N0. `�' ;� O ! '1 DATE ��/ ,-/�� ! <br /> . <br /> t . <br /> Service Address �-� -� � ' .•-_ /-- � Utility Account No. <br /> Billing Address ��U � �-' � ' Permit Fee ���' �� <br /> City, State, Zip � ;-G'�- %! - �� Connection Charge�s) <br /> Owner (Mortgagor) � o ='��� , % Total Fee % </ � <br /> � <br /> Billing Name ! , � � <br /> Connection By_ ,, <br /> � <br /> Address � �� <br /> ti�� � <br /> Signed-•-•� , ,, .�.. .�.�` _. <br /> 7 �-' Customer <br /> Phone- .i S�` ' � % .'� ✓ <br /> I <br /> DESCRIPTION: ; t <br /> Lot_l'� - /L� Sewer District ' r � I; <br /> - Block y <br /> Plat�� . .. . i, y . � i � ,. � Monthly Sewer Service --1 %�U # <br /> Unplatted Descrip�ion Monthly Sewer Constr. <br /> i <br /> Type Permit: / �....- i ' -•� . � . � Trunk �•/s __ �i <br /> I <br /> La;eral �' � % i� <br /> _r-. <br /> Remarks: ! <br /> Abutting Lot Line ' <br /> N� S� E� W it. <br /> I <br /> ' � I <br /> APProved By ✓_., ,. �, <br /> a�v e�o��ax , <br /> ,i � <br /> Issued By / . ,r- ,� � <br /> 1 <br /> � ^ f <br /> � Inspection By � �' � ; <br /> y - - --- JDate lnspected�_� <br /> SEE SKETCH ATTACHED N0. <br /> � iri �� , � <br /> � � <br />