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$-3 E H <br />rC�xx <br />Y SyH CA[HZH <br />KH� <br />'Otl CA 1-3 <br />xxx <br />OH <br />Hag <br />H <br />Z H <br />�HH <br />gto <br />H <br />0dCA <br />ZHtn <br />a30CA <br />everett <br />e <br />City of Everett <br />Sewer Applicat <br />NO. 28428 <br />CHART NO, <br />TO POSTING <br />9 S S FS <br />•.rr. x� :i�i r i r <br />r �) <br />ion and Per-IJA <br />� <br />L <br />..-3 <br />DATE n,()2/�+ <br />Seivice Address 3210'Vine St <br />Billing Address 72n re r sr <br />City, State, Zip r r ty F 1' +rr nr r <br />Owner Lycrett VA 9-'2(%1 <br />Connection L, <br />Address <br />Phone <br />Legal Description: <br />I <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permit <br />Remarks — <br />( 2, off <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Water $ <br />Sewer $ <br />Total Development Fee $ <br />Sewei Bond District <br />Abutting Lot Line <br />N, S. E, W — <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />2�/L j� rQ2/ffll�� <br />Nu. 28423 <br />c; 2-- <br />ft. <br />