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i <br /> ( <br /> i <br /> CHART NO._ — <br /> everen <br /> e � <br /> � <br /> City ot Everott g � � � g 8 S � <br /> � � � � � � � � a <br /> Sev�er Applicotior�a � r °� � �, ~ � � <br /> ��� �� � � � � <br /> �+ � � � � � � � � <br /> NO. 2768v DATE <br /> Service Address U10 w G�lee AA. _ Utility Account No. <br /> Billing Address �1�� „ bO�9�b �1 Permit Fee _. ;.� � <br /> City,State, Zip N�«�' � 9�1�7 Connection Charge�s) 92i 00 <br /> Owner (Mor!qapor� � y���•.a Total Fee �0 00 <br /> tkt Utilit7� Dnr+�lpp�nt 1M. Ord. 11�1-lSr <br /> BilHng Neme e� vat�r 2976.00 <br /> ��= 7W6.00 <br /> Connection By aw 10623.00 <br /> Address Signed <br /> � c�m,�, <br /> Phone ��+-+�+ <br /> DESCRIPTION: Sewer District �� III <br /> Lot_�� Block — Monthly Sewer Service <br /> Plat <br /> Unpletted Description Monthly Sewer Constr. <br /> Trunk � �..+ � <br /> Typa Permit: � ��� <br /> — Lateral "' <br /> Remarks: <br /> Abuttinp Lot Line <br /> j�, E, yy �Rc ft. <br /> — APProved By iam�Y CR71N!'OAD <br /> C�ry Enqineer <br /> IMPORTANTI <br /> Issued By ��+�' �=L� <br /> CALL 1�800d24•6655 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 26811811CFOR INSPECTION � <br /> Inspection 8y / — <br /> Date �nspecteJ � �� � ,.��J <br /> I SEE SKETCH ATTACHED ��`�vov <br /> If..';'CC i 10.'�•: <br /> i <br /> � <br />