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_' <br /> , <br /> y��, CHART NO. — I <br /> � � everett <br /> � '' - <br /> N�� _: <br /> ��� c�tyote�erett _ : TO POSTING._J`�l� <br /> ���" S�wer Application and Permit <br /> �< � - <br /> ��� _: _ _ �: <br /> ` �4 _ <br /> �"N� NO. 2�sJ2 DATE �rAor�,7� 1992 <br /> H <br /> �q H Service Address �+ tnr1�.c Utility Account No. <br /> �G0 Billing Address <br /> �y� City, State,Zip �• v` na�m _ Permit Fee $ �n_nn <br /> Ou <br /> � � Owner � >> 9 h - — ConnectionCharge <br /> Connaction by Trunk $ <br /> IAddress Lateral $ <br /> I ____ Total Connection Charge $ <br /> � <br /> Phone _2'�-6�'�i — Utility Development Fee <br /> I ��� Legal Description: Water $ <br /> � � <br /> Lot Sewer $— <br /> � ��+� Biock Total Development Fee $ <br /> L�� <br /> i Plat <br /> ' '„� Unplatled Description: — Sewer Bond District _ <br /> I <br /> �.� Abutting Lot Line <br /> N,S, E,W n' <br /> ; ��� <br /> � � Type of Permit Rannir Approved By * A k i <br /> Remarks Issued By K aughco <br /> i � Customer Signature <br /> ��� <br /> j IMPORTANT! <br /> I � <br /> �.>�,� CALL 1-800-424-5555 48-HOURS <br /> I PRIOR f0 DIGGING / <br /> Inspection By ���`� � <br /> �' CALL 259-8810 FOR INSPECTION <br /> Date Inspected '"��' �Z <br /> SEE SKETCH ATTACHED No. 28652 <br /> INSpECTION <br />