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� . :l <br />��� <br />,o�Zx <br />>Hxti <br />H z3 <br />� H ,.�ro <br />^�A H'�d <br />C/] N <br />��� <br />OH <br />H/� C+9 � <br />y� V CC]. <br />Y, H 3 <br />��'z <br />HH <br />� <br />gd� <br />��� <br />a H cn <br />H O tn <br />'� everett <br />� <br />� <br />City of Everett <br />CHART NO. <br />TO POSTING << -z�-4 z <br />Sewer Application and Permit <br />NO. Z H�G �J O DATE �e�� i99� <br />ServiceAddress +o^a a �nr+iti n�Yd <br />Billing Address —i?5�3—;z . <br />City, Stale, Zip ��� �s ^ea2C — <br />Owner r� k ^"•''' <br />Connecqon by �+.. �'�! ��� �/o <br />Address <br />Phone %�B-0643 <br />Legal Description: <br />Lot <br />Bloc! <br />Plat <br />Unplatted Description: <br />Type of Permit _��,t �^^+�*� <br />Remarks <br />IMPORTANT! <br />CALL 1-B00-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utilily Account No. <br />Permit Fee S <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />NJater <br />Sewer <br />Total Developmenl Fee <br />$ 450 00 <br />$ z�a.00 <br />$ 720.00 <br />� _ 'I'l A nIl <br />$ 509 00 <br />$ etv on <br />Sewer Bond Dislricl B�d 2I <br />Abutting Lot Une <br />N, S, E, W TM. <br />Approved By — <br />Issued By �T �+ <br />Customer Signature <br />��7 <br />�, <br />�.�� ��Icjl <br />��P �I`� � <br />Inspectian By "�`'��2 /"'—' <br />Date Inspected _ �' 'Z �" r l <br />INSPGCTION <br />No.2825�J <br />