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rverett <br />e <br />City of Evarsct <br />Sewer Application and Permit <br />CHART NO. <br />c,'r,,:: 7n i/iF�i-r%a4i <br />l �?—'�� <br />N0. Gv��� DATE �'—' <br />Utility Account No. <br />$ervice Addl+�w � <br />Billing Address <br />City, State, 2ip <br />,_ _ w�L\�� <br />OWf1M �MOft9890�) � <br />Billing Name <br />Connection BY <br />Address <br />Permit Fee <br />Connection Charge(s) <br />Total <br />S�gned c�no�, <br />Phone <br />$ewer District <br />DESCRIPTION: <br />Lot 13 11 Block �� Monthly Sewer Service. <br />Plat Monthly Sewer Constr. <br />Unpletted Description <br />Permit: <br />CALL 1$00-024-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL259S81'.FORINSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />ry, S, E, W <br />Approved By �� R• �L <br />C�tV Enpinett <br />04;1'i/F37 1%=�t;iH1 (�i14�;A4898 tX�Xt <br />Issued BY S� � � <br />p �'LU 41..'.XI <br />t{Oi.�'6149 <br />•',EIA}? '!:.`.iQ <br />pO1101k',055 <br />inspection By „ : ,1.. <br />}q�;'G 1:;0 <br />Datelnspected ��,Q �1A <br />ii�:L'i: N0. �'i'aZ•iJ <br />INSP6CTION <br />