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everett <br />cny m everen <br />Sewer Application and Permit <br />NO. Z H O 7% DATE �_'7 . �i 1 <br />Service Address � � �� L b��— Utiliry Account No. <br />e�iurp iwaress <br />Ciry, Stete, Zip <br />Owr�er <br />Connection bY ��� � � (�—�'.ue ►. � 1� �- <br />Addresa <br />Pfqne _ <br />Lepel Deacription: <br />Lot <br />Bbdc <br />Plat <br />Permit Fee S <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connectbn Charae <br />U!ility Development Fee <br />water <br />Sewer <br />Total Development Fee <br />Unpletted Deccription: Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Type of PertnR � n Ia 1 v- �z��/�.��1 Approved By — <br />S <br />S <br />E <br />a <br />E <br />a <br />Remerke , � � � - Issued By � 1�J�1—%Yl/ ��i� <br />. <br />,,� �- � „_/ /� � d �� C�X'�- CusromerSignature <br />� .c-U !. L,�c.2' . /YIn,fJ iZ' J� /Z' .:. o ' l,�N «� ii ��s. <br />� �^ f IMPORTANT! S G c� � � <br />, <br />s s '/' r.� � f'�L <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING / �" � � <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />1 ,. <br />Inspection By . � � � � - �—' - <br />Date Inspeclod ' <br />uru r��r t'sn_i.r,�r <br />NO. 28O�I7 <br />� <br />