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everett <br />e <br />City of Ewrett <br />S@W@I' <br />� � <br />� �8$�� S $���$ <br />.� :� �i r' <br />i .+ <br />��� � � »���� <br />ApPlitatic�rL � � r � <br />r i�nc�'P� � � , <br />' a��:-4.��� <br />N0. Z74%1 D�E $� L�C uy w .. .. <br />,Tasu�sy 10 1990 <br />$ervice Address 7107 !�v i�. <br />Billinp Address =� �! �• � <br />City, State, 2ip � s«� � �� <br />Ownx (Mortgagorl ��1 L. �oif�� <br />Biilinp Name � <br />Connection By �� <br />Addross � <br />Phone 33Ml07i <br />DESCRIPTION: <br />CFIART <br />Tn pO�TING v?�- <br />s� <br />�� <br />w <br />�� <br />Utility Account No. <br />Permit Fee 30 00 <br />Connection Charge�s) �� � <br />Total Fee � � <br />ociish �•+l�c r.. ora. un-�s <br />Mt�s 22�.00 <br />w�c �.� <br />' , �y�.00 � <br />Signed + cwco�r <br />Sewer District �d iii <br />Lot_.—i- B��k Monthly Sewer Service <br />Plat �� �� <br />Unpietted Description Monthly Sewer Co�str. <br />Trunk �'�-°° — <br />Permit: <br />Remarks: <br />IMPORTANTI <br />CALL 1�800�424b555 48-HOURS <br />pRIOR TO DIGGING <br />CALL 269b611 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By �'-- – �� <br />c�a e�M.. <br />Issued BY ' <br />� A <br />Inspection By��� / �'�""— <br />Date lnspected��:�s�-- <br />No. 27471 <br />INSPFCTION <br />