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everett <br />e <br />City of Everott <br />CHART N0. <br />SE�r 7b fw�,vtsi,arb / -� -17 <br />Sewer Application and Permit <br />No. 25524 DATE �_i�, 1956 <br />Service Address Utility Account <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lot_.� Block_ <br />Plat <br />U�platted Description <br />Typa Permit: <br />Remarks: <br />IMPORTANT! <br />CALL 1-BOOd24•555548-HOURS <br />PRIOR TO DIGGING <br />CALL 259A811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Permit Fee <br />Connection Chargels) � <br />Total Fee <br />Sp�e1a1 S� F� Ord 1171-e5 <br />Mat� 179.OY <br />Swwr 471_00 <br />a�0.00 <br />Signed ' ��� <br />Cu e <br />Sewer D�strict <br />Monthly Sewer Service_ <br />Monthly Sewer Constr. <br />Trunk <br />Laterel <br />. <br />Abutting Lot Line <br />N, S, E, yy ft. <br />Approved By A_ !_ Thrl <br />Ciry Enpinear <br />Issued By Su! aL°u�� <br />/ <br />Inspection By <br />Date Inspected 5 ��po <br />INSPECTION <br />No. 25524 <br />