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everett <br />e <br />aey ot e��en <br />Sewer ��plication and Permit <br />CHART NO. <br />�, i �o Cfa..�� 'f�i�6 <br />No. 25924 DATE M*�,_��2G, 1986 � <br />Service Address Utility Account No. <br />Billing Address <br />City, SUte, Zip ` <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Phone <br />DESCRIPTI ON: <br />Lot�o Block <br />Permit Fee . <br />1 �1/86 2:U3DH OD►Xifk"SN3 tttt <br />Connection Charge�s)� � <br />Total Fee__3 =-'`� <br />Speeli7 'fttlit QMS��I'85 <br />Mster �"i?G '�1 41.� <br />Sawa� �:1 � s75.00 <br />s:�.[m <br />Signed unna.y2a <br />c"�`f�S? s'�. W <br />17fA) II SicY1.00 <br />11 i 1-.'i 1d50. W <br />Swver District � <br />Monthly Sewer Serv� ��� <br />Plat _ <br />Unplatted Oescription Monthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />Trunk__��_ <br />Lateral <br />-�D�'.: L°�- <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By <br />ciev enyfneer <br />Issued By_� <br />� <br />Inspection By <br />Datelnspected � <br />INSPECi"fQN <br />No. 25924 <br />