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CHART N0. <br /> everett <br /> �,�,�- 2a-S <br /> � <br /> City of Evmett ��$� <br /> Sewer Application and Permit <br /> NO. 2G1OS DATE � — I ' v7 _ <br /> Service Address 2 � 0 � („i``e� �A ND Utility Account No. <br /> G <br /> Billing Address Permit Fee <br /> City,State, Zip Connection Chargels) <br /> Owner (Mortgagor) _ Total Fee <br /> Billing Name <br /> Connection8y �1 'f'�l O � �V�.tG��"' <br /> Addreu Signed <br /> cu��ome, <br /> �10118 <br /> w.- <br /> DESCRIPTION: Sewer District <br /> Lot Block <br /> Plet Monthly SeWer Service <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Typa Permit: � {�q � <br /> 1�� Lateral <br /> Remarks: =cG�iocof ioc. u�� ma . <br /> = —T Abutting Lot Line <br /> /O/ ' o �n r+.v N, S, E, W ft. <br /> � � � ,. � <br /> �a ,�.� .� `� %d ' <br /> �n�• Approved By <br /> City Enpinen <br /> IMPORTANTI <br /> CALL 1$00�424-6665 48•HOURS Issued By <br /> PRIOH TO DIGGINO <br /> CALL 269�8811 FOR INSPECTION �� ) .� ,� <br /> Inspection By -� � <br /> Datelnspected 7 "o " 6 7 <br /> SEE SKETCH ATTACHED No. 26105 <br /> U'TILITY CILLING <br />