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�i�y� <br />�1 y <br />�Hy <br />K�n <br />H �1 <br />Ox0 <br />� y H <br />z <br />�'�o <br />OH <br />�^�g <br />y, V � <br />z r+ � <br />H <br />��H <br />�� <br />H <br />o�w <br />r <br />P7 <br />H O Vi <br />� <br />�� <br />everetl <br />� � 0 POSTIN <br />T <br />cicy ot everen _ - - = 7, _ <br />�ewer APplication, Land Permit <br />N0. Z f 739- . _ .. _ DATE `. r :� - " '__ <br />Y � <br />ServiceAddress �+++ �-- ---. <br />Billing Address�.��.�_y,� <br />f,ity, Sta[e, Zip__ F.Verett, WA 90203 <br />Owner (Mortgagori_� �s <br />Billing Nam <br />Connection <br />Address_ <br />Phone_ <br />DESCRIPTION: <br />Lot <br />Plat <br />Unplatted Descr <br />Block <br />Utili[y Account No. <br />Permit Fee_3S <br />Connection Chargel <br />Total F <br />_ Os�dinance 1171-PS i <br />wntcr only - 179.00 <br />— �/J � I <br />_ Si9ned - � - � � . , • --_"- i <br />�cu:�ome, <br />Sewer District <br />Monthly Sewer Service <br />_ Monthly Sewer Constr. <br />— r_.._�. <br />Type Fcrmit: <br />�ie::-�t.aeeE £ eef—(�--j <br />Lateral <br />Remarks: <br />Abutting Lot Line <br />� N, S, E. W <br />CALL 759 881 j, FOR INSPEC lON <br />SEESKETCH ATTACHED <br />A pproved By <br />E <br />�1r•'+�'yLi <br />/ <br />Inspection By—�`� � � � <br />Datelnspected �-��^-5'L <br />!�::�� ..i'.-1 iC�.i <br />r�o. 27739 <br />