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_ .., ' CHART NO._ <br /> everett <br /> � SE,vr rc fyA�r�.� /Z /30�96 <br /> City of Everott <br /> (k116/H6 4:4 WM W0f1M0532 tttl <br /> ! <br /> Sewer Ap�a�icction and Permit � �15.� <br /> �� ��.� <br /> /� P1.98 t24,W <br /> No. �5b75 DATE ItiCH l25.50 <br /> //p/3 • <br /> � � ryJ �',� �y� R '',.,PL�1 f 1.50 <br /> Service Address � � � � �=����/11��%y�%n'!� Utility Acr,ount No. ��xQ 460 �n <br /> � SEYF.R �30.00 <br /> Billing Address % � Permit Fee - P�M1 II ��!1D <br /> i _11,71-5: t2"c4.00 _7- <br /> City,State, 2ip ' � - Connection Charge�s) �S 6�2r�'S'S0 " <br /> ' ; • � �� �;� . � . � <br /> Owner (Mortgagor) - ' �Total Fee <br /> Billing Name ` - � � �� <br /> Connection By - � � <br /> Address `- Signed `" �.�' ' t,r�:,_-l_ <br /> Cusromer <br /> ,� / - 1 <br /> Phone - <br /> DESCRIPTIQN: Sewer District <br /> Lot � Block <br /> � Monthly Sewer Service — <br /> Plat �� //�QD <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Typa Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By �"-' <br /> cltv efpineer <br /> IMPORTANTI <br /> Issued By <br /> CALL 1500�424-5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8871 FOR INSPECTION � / <br /> Inspection By �> l �*'�✓P�`- -- <br /> Date lnspected �'���6 <br /> SEE SKETCH ATTACHED Np, Z`�67� <br /> I�SP[CTION <br />