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CHART N0. — <br />evereri <br />e <br />City of Everstt <br />Sewer Application and Permit <br />NO. Zv489 DATE _ — � <br />Service Address ��� *1�� � Utility h,ccount No. <br />Billing Addresa �1 �• ■ ]�� �7e7 — <br />City, Stete, Zip �••�t._ o fsl9± <br />pMmer (Mortgegor) �'� <br />&Ilinp Name � <br />Connectan BY � — <br />Addreas �� <br />� 5�7�1� <br />; pESCRIPTION: <br />Block <br />'fNt __ <br />� G�c:�;.� c� f�,�8g <br />Permit Fee +^-�+i+ — <br />Connection Chargels)�pp.0�- <br />Total Fee M M <br />ip�oiai Oetlity tw Oed. li�l-eS <br />ratrr 179.00 <br />�Nr �71.00 � <br />Signed <br />I,S`���00� _1 :i.��y <br />c���,�� <br />Sewer District_ �0� _ <br />Monthly Sewer Service <br />ur�l�tted Dacription Monthly Se�ver Constr. <br />Trunk �•� <br />Pxmit: <br />R«narks: <br />IMPORTANTI <br />CALL 1�OOd24b666 48-HOURS <br />PRIOR TO DIGGING <br />CALL 269�811 FOR INSPECTION <br />SEE SKETCH ATTACH�D <br />Lateral ��•� <br />Abutting Lot Line <br />N, S E, W ft. <br />Oi/14/88 3�1.�( OOOANBBOB #� <br />/ . <br />MOOOf92�1 <br />Approved By <br />�KS. <br />t24.00 <br />Issued By �-=°1� � <br />E �tli1 �13.00 <br />QRiNr �s^.0.0(1 <br />� <br />Inspection By.� Ii0i1 oD <br />Date I nspected 11��1�0� <br />� N ' . 489 <br />INSPECTION <br />