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CHART NO. <br /> everetl <br /> e <br /> City of Everott ( <br /> Sewer Application ond Permit s�,� Ta �F'�%T,�f �/�/86 <br /> No. 25343 DATE 11/25/BS <br /> ss�o c.a:: <br /> Service Address Utility Account No. — <br /> Billing Address �12 �� Permit Fee �'� <br /> City,State, Zip �ritt, Ih. 9s201 �nnection Chargels) <br /> «M �� 30.00 <br /> Owner (Mortgagor) Total Fee <br /> Billing Name Ordin+uw� 1171-85 <br /> 8wwr 76�.25 <br /> Connection By .. M�t�r 389.85 10'3�.10 <br /> Address Signed �1 ' ` `^ � •, ' ' d-� <br /> T—� cuitomer� <br /> Phone <br /> ���079! � ' , <br /> DESCRIPTION: Sewer District <br /> Lot ss"6� _ Block 6f� Monthly Sewer Servica <br /> Plat �+�t L�A Co's i�t <br /> Unp�atted Description Monthly Sewer Constr. <br /> — Trunk <br /> Typa Permit: Ilw Oe�n�otien <br /> Lateral <br /> Remarks: �i� �Q� �l <br /> 1�Y Abutting Lot Line <br /> e...�.. rw •.�,^t� _ N, S, E. W it. <br /> i <br /> Approved By �' �' � <br /> ciry enyfn«r <br /> IMPORTANTI E. � <br /> Issued By <br /> CALL 1�800�424-6655 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 269A811 POR INSPECTION <br /> Inspection By�� � ��-° /�"'-- <br /> __ _ Date I nspected G - 3 0 -�,� <br /> SEE SKETCH ATTACHED No. 25343 <br /> �r.;r��criora <br />