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'�� <br />� �� <br />everett <br />e <br />City of Evcrett <br />::tn PO�TIN <br />� , -. ; <br />_ _, s <br />'F - O f <br />;; ... , <br />�� <br />Sewer Applicatior�a�c�;P; <br />No.285�.3 <br />�, ��w-�: <br />� �=�_c 3' :4 : <br />DATE' oce. 2i _ _ <br />Service Address Ss08 s. 2nd l�ve <br />Billing Address 5002 s znd wve <br />City, State, Zip TM� �� �`��A <br />Owner ��d Pardae <br />Connection by Kan MCCallister <br />Address 9^ A^ 'd�`. <br />ce...�t� wu a8203 <br />Phone �ea-antn <br />Legai Description: <br />Lot D <br />Block <br />Plat <br />Unplatted Description: <br />Type of Permil Nert rnnnect Lon <br />Remarks <br />I�dPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-861Q FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utiliry Accoun[ No. <br />I'ermit Fee $ <br />Conneclion Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Development Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond District II <br />Abutting Lot Line <br />N, S, E, W <br />Appro.ed By <br />ISSUBd BY HufThnr <br />Customer Signature <br />30.00 <br />g eto_oo <br />$ a�o.00 <br />720 <br />$ E56.00 <br />$ 179.06 <br />$ �21�Qp <br />g _�so on <br />�// <br />Inspection By -h�G=t--� <br />Date Inspected � -1� -�'� <br />wsP�cTior� <br />No. 28513 <br />fl. <br />i <br />'i <br />,: <br />