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CHART NO. <br /> everett ' <br /> ;-. _ <br /> ;c t a �� v s�, n.c� <br /> r � <br /> � ' O/�, �� <br /> City of Everett �, G � <br /> :� ... <br /> Sewer � lication and Permit <br /> ^ �:� _ <br /> � - ,:, <br /> NO. ���� DATE <br /> , <br /> Service Address —}��� -- Utility Account No. <br /> Bllling Address " <br /> City, State,Z_� �*A�, T+s Q��Ol Permit Fee $ <br /> Owner ;y...-.. �-�� Connection Charge • <br /> Connection by Trunk $ <br /> Address 54�1 �n.w lateral $ _ <br /> �-�--�+�- �*• �e++� Total Connection Charge $ <br /> Fhone �;q ;�u Utility Llevelopment Fee <br /> Legal Description: Water $ <br /> Lot Sewer $ <br /> Block Total Development Fee $ <br /> Plat <br /> Unplatted Description: Sewer Bond District <br /> Abutting Lot Line <br /> N,S, E,W ft. <br /> Type of Permit ar.,�gy�rr�y, Approved By <br /> Remarks Issued By <br /> Customer Signature <br /> IMPORTANT! <br /> CALL 1-800-424-5555 48-HOURS ' <br /> PRIOR TO DIGGING � / .. - <br /> Inspection By f�/ ��/``l/' <br /> CALL 259-8810 FOR INSPECTION // <br /> Date Inspected 7-� c- 9/ <br /> SEE SKETCH ATTACHED NO. Z H Z Z1 <br /> I ir�s��cnor� <br />