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CHART N0. <br /> evereri <br /> � � �j,.,�'.� �G,c��`=� /-I 3-8 9 <br /> City of Evzrett � � � ; � <br /> P�i e�'. «M. � a <br /> Sewer Application and Per��= � ,_ � . ,. <br /> 2T004 Q � Y�� � � <br /> N0. DATE ��' 7:1A88 <br /> Service Address w �� �� i�_ Utility Account No. <br /> Billing Address /... Permit Fee 3.50 <br /> City,State, Zip =+++.�.+�..� �...,__.. ,,, .0�3 Connection Charge�s) <br /> Owner (Mortgagor) •�1i�rn �+o�p Total Fee <br /> —4.38 <br /> Billing Name _ �� <br /> Connection By � p�� <br /> � /� <br /> Address +w. �,Z�y� �� �E�� Signed `— � li'F'�"""� <br /> Cusro r <br /> Phone- U� }��7 <br /> DESCRIPTION: Sewer District <br /> Lot 1-21 Block <br /> Monthly Sewer Service <br /> Plat �+..�.�--� i,�q*t� <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: p���: � <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> — N, S, E, W ft. <br /> Approved By ntr�e x. r��L <br /> C+ry Enpineer <br /> IMPORTANTI <br /> CALL 1�800-024•555548•HOURS Issued By �.�q� <br /> PRIOR TO DIGGING <br /> CALL259�871 FOR INSPECTION 1 e�/p� <br /> Inspection By � <br /> — �� <br /> Date Inspected ��� <br /> SEE SKETCH ATTACHED ' "� <br /> / 7��4 <br /> � N0. <br /> INSPECTION <br />� <br />