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i <br /> CHART N0. <br /> � �everett �;'�%,�%� . .� (,;: �:,,� .�-.�_=,;��j <br /> e <br /> City of Evcrett <br /> Sewer Applicction and Permit <br /> NO. 27�76 DaTE Fe�rua:r 1a 1sa� <br /> �e33�- ��� -�F- <br /> I Service Address �:ility Accour�t No. <br /> Billing Address <br /> Permit Fee 30.00 <br /> City,State, Zip Connection Chargels) �� <br /> Owner (Mort�agor) <br /> Total Fee 30.00 <br /> IItility Devalopwant f'e¢ Ord. 1171-65 <br /> Billing Name saver 471.00 <br /> . <br /> Connection By � i ��♦J <br /> Address Signed c�:�o�� <br /> Phone — <br /> I. DESCRIPTION: Sewer District_ H�1� <br /> � �ot Block — <br /> Monthly Sewer Service <br /> Plat <br /> Unpiatted Description Monthly Sewer Constr. <br /> Trunk , . . .. ., .. . . . '. . <br /> Type Permit: / <br /> Lateral <br /> `�:1$It :'A.tm <br /> Remarks: Abu[ting Lot Line ��77•�� f'v71.t�1 <br /> N, g, E, W a��t� im ft. <br /> — APProved By uanEn s '�+t�'Ar. <br /> City Engineer <br /> IMPORTANT! Issued By_�uy �-L�s"...=----- <br /> I CALL 1-800-424-5555 48•HOURS <br /> PRIOR TO DIGGING <br /> CALL 255�8911 FOR INSPECTION , <br /> � ��, ,�. <br /> Inspection B �n �` „ � <br /> Date Inspected�� <br /> SEE SKETCH ATTACHED ( Nt�. L�O�v <br /> I I��SPGCTI ON <br /> I <br /> �� � �, <br /> ' � <br />