Laserfiche WebLink
/ . , ' CHART NO. p Z�- Z 9- S <br /> everett . . � �, �r f • <br /> e � /� / __ <br /> c�ey ot E�e�c /os7�ec� 2- 9O <br /> 1 <br /> � <br /> Sewer Application and Permit <br /> , ;. <br /> I� �y, �. _ , � - s� <br /> NO. 26�OI� I��1 D�/ -- <br /> I <br /> � Service Address,�� U���ta�^ r�L — Utility Account No. <br /> � Permit Fee <br /> � Billing Address <br /> i <br /> � City,State, Zip Connection Chargels) <br /> I <br /> � Owner'(Mortgagor) Total Fee <br /> � <br /> I �Billing Name ;- <br /> fConnection By �- � �' �� ''� � �' �t� Y e 1 j' � � <br /> ' Address Signed ' <br /> � Customer - <br /> Phone <br /> ( DESCRIPTION: Sewer District_ <br /> Lot Block Monthly Sewer Service -. <br /> lNat <br /> I i�nplatted Description Monthly Sewer Constr. <br /> ' — Trunk <br /> � - <br /> � Type Permit: � <br /> � Lateral <br /> ! Remarks: �CG� . d�� �Cc.�l2i�<.-S <br /> I o ^ Abutting Lot Line <br /> (`6rv� O /Y1 i� N S, E, �n/_ ft. <br /> !�/ ' C . O•�N <br /> O.� ��C .5 /l/ r i S <br /> � /h � //V A iCJ t/ . <br /> � � —�� Approved By <br /> / �/ � GryEngmeer <br /> '��7 v�t'��' �/�IMPORTANT! � <br /> � Issued By �o nf M � ��n ''r <br /> CALL 1�800-024-5555 48•HOURS <br /> PRIOH TO 9IGGING <br /> CALL 259�8811 FOR INSPECTION <br /> Inspection By � 7 <br /> Date Inspected �� �a " <br /> SEE SKETCH ATTACHED Np, Z69vZ <br /> UTILITY DILLING <br /> �� <br />