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CHART NO. <br /> everett <br /> /) - � Lj ;n i <br /> e <br /> c�ey o, E,roren ��,�� � �`1� <br /> Sewer Application and Permit < < �� ' � " <br /> , ,;,: f �, <br /> NO. 2611Z DATE e' z8— 87 <br /> Service Address � <br /> Utility Account No.��r — �� � <br /> 8illing Addras�a.— �'Ur- � �� U�z�y{�GPxrmit Fee <br /> City,State, Zip Connection Charge(s) <br /> O�� ,M����) _ Total Fee_ <br /> Billing Name - <br /> Co��ection By � � � ��� ' " <br /> i,ddress Signed �i /�R� c��r� /9/'� ti1 GYL <br /> phone <br /> DESCRIPTION: Sewer District <br /> Lot B��k Monthly Sewer Service_ <br /> Plat — <br /> U�platted Ue�cription Monthly Sewer Constr. <br /> Trunk - <br /> Typs Permit: �f Pi9 i� <br /> / _.� Lateral <br /> //,� � 1/zvmn /77,N i�/ �d <br /> Remarks: �,� ' f� r�/�i✓ . 'i� T U i� � � Abutting Lot Line <br /> S, /� n N, S. E, W <br /> /!c.` nG/J�c ,S. ��, Gv � f� `f �. ���'�.• <br /> ( s�rla.rP r/oo�rs .i/ � <br /> / S W� ��'� ' Approved By <br /> City Enpineer <br /> IMPORTANT! Issued BY <br /> CAI.L 1�800d24�5555 48-HOU RS <br /> ' PR�OR TO DIGGING <br /> CALL 2595817 FOR INSFECTION � ����-�y, _ <br /> Inspection By <br /> Datelnspected ' �� p 7 <br /> -- No. 26112 <br /> SEE SKETCH ATTACHED <br /> U"i II_IT`( f31LLING � <br /> � . <br />