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everett <br />e <br />City of EveiBtt <br />Sewer Applicatio� <br />No. 26859 DATE <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Type Permit: <br />Remarks: <br />Block <br />I`J <br />� <br />� g�� <br />a <br />:y IA� <br />, CJ N � <br />c�nd Permi� ,� � <br />� <br />� € �� <br />�� � � ` <br />� <br />Seatnnl»r 19:'1988 <br />IMPORTANT! <br />CALL t$00�424•5555 4Q•HOURS <br />PRIOR TO DIGGING <br />CALL 259�8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account <br />CHART <br />�,L.�t"l �JC�G4C�+`�� / 2(-8 1 <br />. <br />���� � �g�� <br />�r�o-i� p�oui <br />,-+ M� ,� V L� t� 4: t'1 <br />ys N� M C" J L— <br />v� -n ria Cl <br />� 6, u+ <br />N <br />T �i y .1 <br />V t�' � �� �1 � <br />�������� `'� <br />�, .. <br />a mu�a `�xu�. �� <br />Permit Fee ��•� <br />Connection Chargels) 720.00 <br />Total Fee 30.00 <br />R IItility De�alopw�nt Fee Oeed. 1171-85 <br />water 179.00 <br />swer �71.00 <br />65Q.00 <br />Signed <br />Cusromer <br />Sewer District eamd Zt _ <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk 270 00 <br />Lateral 450. oo _ <br />Abutting Lot Line <br />N, S, E, W <br />Approved By • rn e �nrcir. <br />Ciry Enpineer <br />Issued 8y s�� '•Q"' <br />Inspection By v <br />Date Inspected �l� � <br />No. 2�sys <br />I NSPG::TI ON <br />