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H O H . - +d � � � -• - <br /> �, � � � <br /> m � x <br /> � y �' CHART N0. � <br /> y �H everett <br /> K � <br /> H 7C <br /> H �~ � .- <br /> Tp pOSTIt�G _s�"z__ °"-- <br /> � o� - k �: <br /> o H d I City of Everett � �. <br /> � � g � �.- - <br /> �1]Y �] <br /> � H� Sew�r Qpplicafion and; .P'ermit <br /> ��� NO. Z H��.Z DATE ���-- <br /> i <br /> y o � Service Address ��y Utility Account No. _ <br /> � Billing Address ---See <br /> City,State,Zip _ Ol Pe�mit Fee $ 10 00 <br /> �I Owner Connection Charge <br /> � Connection by Trunk S— <br /> I Address Lateral $ <br /> � _ Total Connection Charge $ <br /> I Phone Utility Development Fee <br /> � `� Legal Description: Water $ - <br /> ! <br /> 1 ; Lot Sewer $ <br /> �'�+'' Block Total Development Fee $ � <br /> �' �� I <br /> 'I Plat <br /> I <br /> Unplatted Descriplion: Sewer Bond District � <br /> I �"+ Abutting Lot Line I <br /> N, S, E,W fL I <br /> ' �r <br /> � � Type of Permit Approved By <br /> � <br /> Remarks Issued By I <br /> II � 1�'! Customer SignaWre <br /> IMPORTANT! <br /> �w�'��� <br /> CALL 1-500-424-5555 48-HOURS n,� �%''s�'����'"' <br /> /� ° � I <br /> PRIOR TO DIGGING ��� I <br /> Inspection By <br /> CALL 259-8810 FOR INSPECTION tn J� Z. I <br /> Date Inspected - I <br /> SEE SKETCH ATTACHED No. 2871?_ I <br /> I <br /> u�sr�r_cTioN �I <br />