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i <br /> CHART NO. ` -` ' � � - <br /> everen =� ��z� <br /> e �. -�:= � <br /> City of Everott <br /> Sewer Application and Permit <br /> N0. ZG96O DATE �" I �I �� J <br /> Service Address��rJ��- Utility Account No. <br /> Billing Address Permit Fee <br /> City,State, Zip Connection Chargels) <br /> Owner (Mortgagor) Total Fee <br /> Billing Name <br /> Connection By�v �� G U e ���. t t <br /> Address Signed — <br /> cu:tomer <br /> �� <br /> �10�@ '� <br /> x+ <br /> DESCRIPTION� Sewer District <br /> Lot Block Monthly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> Remarks: � �� <br /> Ab�tting Lot Line <br /> i N, S, E, W ft. <br /> gu sJ�r� "���p�i�J � ✓ <br /> /v L / <br /> � � . <br /> Approved By <br /> Ciry Enpinea <br /> IMPORTANT! j�o N M � I(C r <br /> Issued By� <br /> - CALL 1-BOOd24•5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 259-8811 FOR�INSPECTION <br /> � Inspection By <br /> Date I nspected �r ' � � � �/ I <br /> SEE'SKETCH ATTACHED � N0. �v`�vO <br /> U"T'ILl�fl' f31LLING <br />