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everett " <br />e � <br />City of Everen � 4�{�' `(�; , r,;• I <br />N N • O <br />�T M M <br />Sewer Applicati\ �����ermit <br />NO. Z%J7�. UATE ��� �r <br />ServiceAddress �5,���',�.,�,ST <br />BillingAddress P�gc�2nq' � <br />cny, sfa�e, zia �-i,k !n � r� L� A 48Di 3 <br />Owner — <br />Connection by <br />Address . <br />Phone _�"���� S <br />Legal Description: <br />Lot <br />Block <br />Plat <br />Unpleded Description: <br />Type of Permit [n n f)�#� <br />Remarks <br />� <br />u} P <br />IMPORTANT! �/� <br />�/ <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utiliry Aaaunt No. <br />CHART NO. <br />iv ��CS/i,� <br />l p'�((o�5•� <br />Permtl Fee S <br />Connection Charge <br />Trunk <br />Laterai <br />Total Connectbn Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />S <br />E <br />E <br />a <br />S <br />a <br />Sewer Bond District <br />Abutting Lot Line <br />N,S�E�W tt. <br />Approved By <br />Issued By <br />Customer Signature <br />Inspeaion By _ <br />Date Inspected <br />INSP[CTIO� J <br />NO. Z%9OI. <br />