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H O H <br />�9H <br />C �1 H <br />AHxIn <br />Hz� <br />K O <br />H OS0 <br />H <br />O-3 C7 <br />OH <br />c�• c� <br />H <br />zH <br />'I r3 z <br />HH <br />CZ <br />O <br />H <br />c� C7 rn <br />� tin <br />zHrn <br />H o r� <br />C—a <br />1 � <br />t <br />LIJ <br />eve <br />el <br />City of Everett <br />CHART NO. <br />Tn mrTH,li; h - 7� -R Z <br />Sewer Application and Permit <br />NO. 2 R F ? t DATE —_sue .—:7-,—:982 <br />Service Address _16 <br />Billing Address <br />City, State, Zip ;,vpet -,,,;—; al <br />Owner -- ' <br />Connection byo,• <br />Address �tei� 24 r <br />�a��y.A nnnon <br />Phone — <br />Legal Description: <br />Lot <br />Block <br />Plat -- <br />Unplatted Description: <br />Type of Permit <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ _2.59 — <br />Connection Charge <br />Trunk $ <br />Lateral $ <br />Total Connection Charge $ <br />Utility Development Fee <br />Wa',er $ <br />Sewer $ <br />Total Development Fee $ <br />Sewer Bond District <br />Auutting Lot Line <br />N, S, E, W <br />Approved By <br />Issued By <br />Customer Signature <br />Inspection By _ <br />Date Inspected <br />INSPECTION <br />No. 28621 <br />ft. <br />4 <br />