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CHART N0. <br /> everett <br /> R .� <br /> � / �� �� ` r <br /> S` � <br /> City of Evsrett /fi4� <br /> �/ss <br /> Sewer Application and Permit <br /> No. 2 610 4 DATE ��1�-2� �� 81 <br /> Service Address� � � � ��-1 � � o N Utility Account No. <br /> Billing Address Permit Fee <br /> City,State, Zip Connection Charge�s) <br /> Ownar (Mortgegor) Total Fee <br /> Billing Name <br /> Connection 8y ��..�� O � £ .Y�� <br /> Addrass Signed <br /> cu:tomer <br /> Phone <br /> DESCRIPTION: Sewer District <br /> �pt Block Monthly Sewer Service <br /> Plat <br /> Unpi�ttad Description Monthly Sewer Constr. <br /> Trunk .— <br /> Typs Permit: �. � r <br /> Lateral <br /> R°m°►ks' � � S� Abutting Lot Line <br /> � p ef N� g� E� yy ft. <br /> e a/ ` ,�- ' f .i?. . <br /> Approved By <br /> /hq �ti is iu l3.�I Sh.�pe ����E�,���. <br /> IMPORTANTI <br /> Issued B� <br /> CALL 7-BOOd245655 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259�817 FOR INSPECTION � � �_ _ / <br /> Inspection By –"' «�'�Z.� <br /> Date I nspected,��?�'— �7 <br /> SEE SKETCH ATTACHED ,vo. 26104 <br /> CUSTOMER COPY <br />