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eve�ett <br />e <br />city oi Everen <br />Sewer Application and Permit <br />CHART NO. <br />,�,E�T -Co �dSTi� <br />� • Z c'h"t <br />N0. Z6SF� DATE � ir-- � <br />Service Address Utility Account No. <br />Bilii�g Address_— <br />City, State, Zip_4 •S, M,I► pY000 - <br />Owner (Mortgagor) �-� ^� -- <br />Billing Name e -- <br />Connection By <br />Address +��� +pg� p� g$ ���elb <br />Phone <br />DESCRIPTION: <br />Lot 10 Block <br />Plat *..r Q+a--- -- <br />Unplatted Description <br />Permit <br />Remarks <br />IMPORTANT! <br />CALL 1�800-024-5555 48-HOURS <br />PRIOR TO DIGGIN:; <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee_�._. <br />Connection Charge�s) <br />Total Fee_ 30.00 <br />octittr n...iopm.nt F.e ora. ii7i-es <br />valer 224.00 <br />C�.'::iiExi L:46Pii Lql(.ilk'�'��:' I R f 6 <br />Signed • <br />�`�;i q��)y65 <br />! L�4i 31 :Li1.;d) <br />FY_f:�i '�iti[I.QO <br />Sewer District - e^^�+ *.*, <br />�,��� —��i) <br />1'l.t! CN 41vi.fi.i <br />Monthly Sewer SerYice ; , <br />l :.�FtiH :15.CA1 <br />_ Monthly Sewer Cor��y�,� ��p,��� <br />— Trunk 4iiah�.l..f3G � <br />� Jli�`:i f:':�F.00 <br />Latera I <br />�NiTf.l•' 3�bU.(hl <br />Nbutting Lot Linei_����� ��1�. � <br />N, S, E, W <br />Approved By nrFRvn tt '++�'l*• <br />Ciry EnBi^eer <br />Issued By s+��� �n��^ <br />1 <br />Inspection By �`'� <br />Date Inspected ' � <br />No. 26863 <br />I i';: I'.: ;'1 I(_ i�i <br />