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everett <br />e F <br />City of Everett u? 4 <br />Sewer Application and PeWIR = z <br />NO. 26240 DATE M Juae 24� 1907 <br />Service Address 4920 Doer St. Utility Account <br />Billing Address Sam <br />City, State, Zip i Ltar ttt VA 96203 <br />Owner (Mortgagor) Greg Gaheio i Shari Harlow <br />Billing Name 81111111110 <br />Connection By Sam <br />Address 9423 tad Dr. SS <br />Phone 318-3920 <br />DESCRIPTION: <br />Lot ` Block <br />Plat E3gasoor HelyLts <br />Unplatted Description <br />Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1.800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />CHART NO <br />8pp � 84pp <br />M C u » ++ <br />M .'n <br />�T <br />Permit Fee_30 00 <br />Connection Charge(s) <br />Total Fee 30t10 <br />Special rtilitp roe ord. 1171-85 <br />rater 224.00 <br />Signed <br />Customer <br />Sewer District Bond II <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W_ <br />Approved By arorRn u nt sr <br />atv Engineer <br />Issued By 91 Y titan <br />Inspection By <br />Date Inspected <br />INSPECTION <br />-% 22-6,e <br />No. 26240 <br />