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. �n��n i rvv. <br /> evereM ��/69 �o�rEp — ��o �vMM� <br /> e <br /> City oi Everatt <br /> Sewer Application cnd Permit <br /> n►o. 264�����,' /a� - � - �� <br /> i° — <br /> Serv ce Address S Utility Account No. <br /> Bllling Address Permit Fee <br /> City,State, Zip Connection Chargels) <br /> Owner (Mortgagor) Total Fee <br /> 8111ing Name <br /> Connection By� �— <br /> Address Signed <br /> cuswmer <br /> Phone <br /> DeSCRIPTION: Sewer District <br /> Lot _ Block <br /> Plst , Monthly Sewer Service <br /> Unplatted Descriptio�i _Monthly Sewer Constr. <br /> Trunk <br /> Typa Permit: � - <br /> Lateral <br /> • Remerks: <br /> Abutting Lot Line <br /> L O N, S, E, W_ n• <br /> � <br /> . / <br /> (�I��/ �� � � Appraved By <br /> �/� , � J G�Y E,iyinav <br /> IMPORTANTI <br /> Issued By �o�' /1'�� I !r r <br /> CALL 5�800�24�6666 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL�69�8871 FOR INSPECTION <br /> Inspection By _. <br /> Datelnspected <br /> SEE SKETCH ATTACHED ,vo. 26415 <br /> UTILITY GILLIf!G <br />