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i <br /> ICHART NO. - --- <br /> Ieverett <br /> I, �� �1 <br /> 1 <br /> � �� _ � d Pas�,Ky �� �6�4, <br /> ti�� _ _ � <br /> c�;r•. _ -, � � s _ <br /> G�H li City of Everett = _ _ - _ _ I <br /> ayv� <br /> y zH I Sewer �►�p1'ication_s�rid_.P�rm�t ; ' <br /> o �o '� � _ = � -: �- � <br /> � m H � NO. �7�7� DATE __�•�us��4,-�.-�'-'U-- — � <br /> y zr , I <br /> o� �� I Service Address Ulility Account No. — � � <br /> _�rS V��":� I <br /> H�o II Billing Address ' ' — ; <br /> y H i �,� Permit Fee S �n nn — I <br /> a �7� Ciry, State,Zip --}'�_.� <br /> r �y � _� Connection Charge <br /> r� �n � Owner - � ---�— <br /> c� C v� 'I I Trunk $ �— <br /> � �t., Connection by � <br /> z y y � Lateral $ <br /> y o y Address — ;n <br /> ; Total Connection Charge $ —u0•�fl � <br /> Phone "s3S-�2� • — Utility Deveiopment Fee '� <br /> � Water � ��� �0 �i <br /> � Legal Description: i <br /> ... ,� <br /> '� Lot Sewer �—�Y7 .2-9t?---- � <br /> !! I Block Total DevelopmeN Fee $ � , �I <br /> (M .� I Plat —___ u�,•�,. ' ' <br /> I � � I i <br /> � ! Unplatted Description:r Sewer Bond District <br /> e� I Abutting Lot Line <br /> !� 1�.S, E.W ft. <br /> f I Type of Permi! �� Approved By III <br /> �'`f i Remarks _ Issued By I, <br /> p---.� ' I _ _ Customer Signawre ' <br /> I <br /> I IMPORTAN'f! I <br /> �,�,�1 � ' � <br /> I CALL 1-800-424•5555 48-HOURS ' <br /> PRIOR TO DIGGING ��� <br /> , I Inspectlon By '�"`� / —' I <br /> I CALL 259-8810 FOR INS?ECTION �_�T- 9i i <br /> Date Inspected _— <br /> � � <br /> II SEE SKETCH ATTACHED NO. 2787E� <br /> � <br /> ; <br />