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everett <br />� ' <br />City of Everatt <br />Sewer Applicatior� and P�rm�t <br />No. 232g4 DATE <br />Service Address_ �a2 y �l J ,(� _���� <br />Billiny Address ,� � ( .�� ..7/1'T� = <br />City, State, Zip u_�2p �j <br />Owner (Mortgagork�%����� �eo��cC� � - <br />Billing Name <br />Connection By <br />Address <br />Phone ��___���,�� <br />CHART N0. '1--'�-��`�'�. <br />Uiility Account Na / 7 / �7 <br />O� <br />Permit Fee_30 <br />�1 O� <br />Connection Charge�sl_.�7 �✓^ <br />r <br />Total Fae__ ,3U � <br />Sign <br />Custamcr <br />r � <br />DESCRIPTIQN: Sevaer DisVict__,�_.,� J — <br />Lat _�_ Block _ �� /J <br />Plat _� Monthl�� Se�.ver Service22•.,�,�y_-:-r{_ ___ <br />Unplatted Desc� tion _ Monthly Sewer Constr. <br />Type Permit <br />Remarks: <br />Trunk /% ,�O_ <br />Lateral �. / /i <br />Abutting Lo[ Line <br />N, S, E, W-- _ . _ �/ <br />Approved <br />[ng,i �_� <br />ISSUC(J BY__._ <br />� i • <br />Inspection By 'i�' � � •,a1 <br />�' i <br />----- ------ --- � Date I <br />SEE SKETCH ATTACHED <br />� i :. <br />No. 23�94 <br />