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� �� <br /> C H <br /> lHtn <br /> H �� <br /> ��� CHART N0. -- <br /> everett '� <br /> � � I <br /> � e � <br /> � <br /> � <br /> ��g <br /> �y� ��ty ot everen TO POSTI NG��/9z i <br /> � <br /> g�y Sewer Application and PE:rmit � <br /> �'�' � NO. Z 79 Z Z DATE -�s�,;cewb�e �A� �n�A � <br /> � <br /> i <br /> Service Address Utility Account No. <br /> Biliing Address --.���„�s��--�; �}R <br /> City, State,Zip Permit Fee $ � <br /> Gwner - Connection Charge �rollecteA r/eldq. !7) � <br /> C�nnectlon by Trunk S i <br /> Address Lateral S i <br /> Total Connection Charge $ i, <br /> � <br /> � � Phone _ Utility Development Fee � <br /> 1�' Legal Description: Water $ z� ,+ �, <br /> � 1 Lot _ _ Sewer $ ao7_s� � <br /> ��' Block — Total Development Fee $ -1+17 0� I, <br /> '�1 Plat i <br /> ��� Unplatled DescdpUon: Sewer Bond District Zir I <br /> '� Abutting Lot Line I <br /> �' N,S,E,W h• � <br /> �' Type ol Permit Approved By <br /> � -- <br /> Remarks _ Issued By—�_„_....�� <br /> � -`_ ; <br /> '-' Customer Signature —_ <br /> ��� IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS �, <br /> PRIOR TO DIGGING /� � ' y� I <br /> CALL 259•8810 FOR INSPECTION Inspection By. ��= � I <br /> � <br /> Dato Inspected <br /> SEE SKETCH ATTACHED NO. 2792� ! <br /> i..���:,�; C11C'W I <br /> I <br />