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i <br /> CHART N0. <br /> everett ��-r-ro �=o��-,�c-, <br /> � � �-�8-� <br /> � <br /> City of cverott � � g <br /> � a o � <br /> M M ✓' <br /> Sewer A� ic�tion and Permit <br /> � � � � � <br /> N0. ���Jw � � DATE — <br /> Service Addreu �� �-- —• — Utility Account No. <br /> Billing Address Permit Fee � <br /> City,State, Zip� Connection Charge(s) <br /> Owner (Mortgagor) Total Fee _ — <br /> Billing Name <br /> Connection By � � . ��. <br /> Address Signed ' "� � . <br /> cmtomer . :, <br /> �. 1� <br /> Phone <br /> DESCRIPTION: Sewer District <br /> Lot Block <br /> Monthly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> Trunk <br /> Type Permit: <br /> Lateral <br /> flemarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> Approved By <br /> ciry �y�oee. <br /> IMPORTANT! <br /> Issued By <br /> CALL 1�00�424•5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 259$611�,FOR INSPECTION �� <br /> Inspection By <br /> Datelnspected G 7-so <br /> SEE SKETCH ATTACHED N0. L���O <br /> i f�SPECTION <br />