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CHART NO. --- <br />everell <br />EN <br />City o" Lverett <br />Se\Ner Application and Permit <br />No. 2831G DATE---- <br />Servic) Address __-_ ;-n rantrfi TY'g Rn=9T— <br />Billing Address --J amr-#e-A*+v►- <br />City, State, Zip -- - "onzett -rm- ye?en <br />_----- <br />Owner —.---ie�---- <br />Connection by --qq i- teta- <br />Address <br />—1oEcts-nv�--- <br />--------swllovuwrLi7�—AAAO� -- <br />Phone---A55-257n <br />L,gal Description: <br />Lot <br />Block _-- - <br />Plat — <br />Unplatted Description: - <br />Type of Permit <br />Remarks <br />IMPORTANT! <br />CALL 1-800.424-5555 48-HOURS <br />PRIOI? TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ — Qp--- �— <br />Connection Charge <br />Trunk $ <br />Lateral $ �— <br />Total Connection Charge $ -- <br />Utility Development Fee t <br />Water Lll.%.7T _ <br />Sewer hrxdNg7, , <br />Total Developmant Fee (µ$ - a10'UO <br />C,(491 t1U.00 <br />Sewer Bond District ------ <br />Abutting Lot Line <br />n. <br />N,S.E,W . <br />Approved By <br />Issued By-- P.-ilel+r- <br />Customer Signature---� <br />Inspection By <br />Date Inspected <br />NO.28316 <br />INSPECTION <br />