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'everett <br />City of Everott <br />CHART N0. <br />�. o Po s t.•, � 9 <br />4-1�-91 <br />Sewer Application and Permit <br />NO. Z$ Z O 3 DATE ,.,T+�.���i <br />ServfoeAddreBs �m� �••.�ti iw — <br />Bllflnp Address �„ � � n �"'�•t �YM — <br />CItY� Stete� ZIP <br />Owr�er <br />Connedfon bY . <br />Address . <br />�ip�� b 9�24• <br />Ph0�18 c�+-+,+, <br />Lepel De�alPtio�. <br />Lot <br />BbCk <br />Plat <br />Unplausd Deecriptbn: <br />Type of Pertnk s�u� <br />Rsmarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FQR INSPECTION <br />SEE SKETCH ATTACHED <br />Ulility Account No. <br />Permit Fee $ le o0 <br />Connection Charge <br />Trunk S <br />Lateral S <br />Total CcnnecHon Cherge S <br />Utility Development Fee <br />Water S <br />Sewer S <br />Total Development Fee S <br />Uh.�ll4/91 L1e�fiAM ODOMl6?49 S'CKC <br />Sewer Bond Distrfct �,'��z <br />Abutting Lot Line ��7? 41Q•� <br />LyF.CY liQ.W _ �. <br />td, S, E, W <br />App �ved By — <br />Issued By — <br />�: <br />Customer Signature z� ' � — <br />Inspectfon By —'�'/�"u <br />Datelnspected y_��� 9� <br />INSPECTION <br />No. 28203 <br />