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everett <br />� <br />Citr of Everott <br />.• �S <br />�o��l��a <br />Sewer Application and Permit <br />No. 2379T <br />DATE L/a�/8 0 <br />112s r�yt ori�• <br />Service Address _ <br />Billing <br />City, State, <br />t.0. 1os 206 <br />LtawM�eA, Na. <br />Owner (Mortgagor) M.t. TiYTLI1 <br />Billing Name �� <br />Co�nection By <br />Address <br />Phone �����« <br />� <br />CHART N0. Z' 7-2$ �S <br />�o-,'f�i� / -2 (-81 <br />Utility Accourt No. <br />Permit Fee_ � �e <br />Connection Chargels)_ <br />Total Fee =•SO <br />�� <br />�y <br />Signed , � • t,.... ..�'�_, t. <br />castomer ' . <br />DESCRIPTION: Sewer District <br />Lot_ Z� _ Block � <br />Piat 1�r1� lark Monthly Sewer Service <br />Unplatted Description Monthly Sewer Constr. <br />Tvoe Permit: caY�=t <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By_ H. 1oa�A�r <br />City Enpinex <br />E. sOnd <br />Issued <br />Inspection By ��r _ Q � � <br />Date Inspected �'z�fj'i —� <br />N�. 23T9T <br />