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CHART NO. <br /> everett <br /> e <br /> c�ey ot e�erecc <br />' Sewer Applicction and Permit <br /> NO. Z498S DATE ,/��1�7 <br /> Service Address ��d� �1�--����� Utility Account No. <br /> �/ � �j �N °1 <br /> Billing Addresst����_1��rJ� '�• �/ '� Permit Fee ,w <br /> City.State, Zi Connection Chargels) <br /> � 3 '`. <br /> Owner (Mortgagor - -Total Fee � <br /> BillingName � ��� �3 � <br /> o?D✓r(o <br /> Connection By L ' <br /> � : <br /> ��1 � � � ! <br /> Address Signed '�� <br /> Cuflomer <br /> Phone ���- �"� ��' <br /> DESCRIPTION: Sewer District <br /> Lot-,�/'�"�`---Block _ � Monthly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk__ <br /> Type Permit: <br /> Lateral <br /> Remarks: Abutting Lot Line �" " �/e_ <br /> N, S, E, W1LS�^��� ft. <br /> — Approved By��`�� <br /> CitY Enqlnem /� <br /> ISSUCd BY �' �f�—Z4- <br /> Inspection By� �a�e� r"'A�^ <br /> Date I nspected T- 2 2 - e� <br /> SEE SKETCH ATTACHED ND• 24985 <br /> INSPECTION <br />