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everen <br />� <br />City of EvereR <br />CHART <br />Sewer Ap�plication and Permit <br />No. 23558 DATE ����5:0 <br />Service Address_��—��"""'�'"�—='— <br />Billing Address �"�. c! • �4'� rt—�� <br />City, State, Zip �x� L!f!L 98 '�O C <br />Owner (Mortgagor)^� G(1ls.liC. %��� <br />�—� <br />Billing Name <br />Connection By�G�t�iO"{-u�""'� ` -��2� • � • <br />Address __ <br />Phone �s/ - ��/ �� <br />Utility Account <br />Permit <br />Connection Charge!s) — <br />,�!'O <br />Total Fee .� � <br />Signed� <br />Customer <br />DESCRIPTION: Sewer District__ <br />�ot �6 Block�� <br />A4onthly Sewer Service <br />Plat�l��.�'� B3 c/� �2�� <br />Unplatted Description Monthly Sewer Constr. <br />Co��.p�c�rc- Nr� ��s,�. ^ <br />SEE 3KETCH ATTACHED <br />INSPF.CTION <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />� �%,� <br />Approved By % - ` Ld/ ����"—J <br />Ciry Engineer <br />Issued By��`� `-"""' . <br />I nspection <br />Date Inspected <br />rvo. 23558 <br />