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� �'� <br />max <br />tY" � V� <br />�as <br />k � <br />�� <br />pH0 <br />� ti <br />Cx-7 G L'7 <br />oHo <br />� n c� <br />Hu c <br />9 �3 � <br />C F-! H <br />� ty c�n <br />� r� r <br />tn <br />HO[�/� <br />everett <br />� <br />_ "�,�4R � = _ _ <br />City of Everett ' -_ _ _ - - " _ <br />Sewer App9icd�ion ant! Perm;�� <br />NO. `�G'F�6GZ JDATE/ ��''� <br />Service Address �t.,,r�._,s.�,.,.` — — — <br />Billin� NddreSs *" n^- �'S' — <br />Ciry, State, Zip ,- -- <br />Owner � . . <br />Connection by — <br />Address _ <br />Phone _ — <br />Legal Description: <br />Lot _�_ <br />Block <br />Plat SF 35- C9 <br />Unplattcd Description: <br />Type ot Permit <br />Reinarks _ <br />� k� .O 1 I IMPORTANT! <br />CALL 1-80f1-424-5555 48-HOURS <br />PRIOIi TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />CHART NJ. <br />7n nnCTl Nf, I - �d -93 <br />PermitFee $ ?O.nn __. <br />Connection Charge <br />Trunk "� -�— I <br />� <br />Laterai $ —��.S.L� � <br />Total Connection Charge $ ___� .� <br />Utiliry Development Fee ' <br />Water $ __ 17�.c�p _ <br />Sewer $ - ,,, i <br />Total Development Fee $ ����•�'� <br />Sewer 9ond Districi __— <br />Abutting Lot Line <br />N� S� E� W � II <br />Approved By i <br />Issued By r.n <br />Customer Signature —T ', <br />/� , ! �� ! <br />Inspection By / _� .<��d%.�,��%� I <br />Date Inspected ' C % 2- 'I <br />I�:::��:-i;iiti"�,-; <br />No.28G62 �� <br />�I <br />