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eve�ett <br />� <br />City of Evsrett <br />Sewer Application and Permit <br />N,,. 25530 DATE � � � +... <br />�`.��� <br />s���e ndd�� ���-�, <br />Billing Address }�F�{� ��,�-- <br />CitY. State, Zip Ep .. u. es�w+ <br />Owner (Mortgagor) <br />Billing Name e� <br />! <br />Connection By .� <br />Address .._.._ <br />Phone s <br />DESCRIPTION: <br />CHART NO. <br />,�.vT 7s t.vA.en..ro� //7/S7 <br />Utility Account No. <br />Permit Fee_ ��� <br />Connection Charge(s) <br />Total Fee_�.� <br />. �� � <br />Signed'� /�� /J/ , •:.i'/�i:1i`�i <br />�, cuNomer � <br />Sewer District <br />Lot�_ Block Monthly Sewer Service <br />Plat ���, <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-600�4245555 4f3•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Trunk_ <br />Abutting Lot Line <br />N, S, E, W ft. <br />Approved By <br />c�ll E"k:°"Ifwl <br />Issued <br />Inspec <br />Date I <br />INSP6CTION <br />No. 25530 <br />