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� <br />everett <br />e <br />City of Evecett <br />Sewer Applicat <br />NO. ZH6�% <br />L: _ ' 4: � � <br />.i _ n C. _, �. <br />- , <br />; _, � <br />. • •- <br />ion and �'err�i�: _ <br />: . � C.i Cr .: <br />-�Y ".. . �,:, —. 4 i v x� <br />.�. ;�i �. ^�. ' <br />� � '� � �� �. � ..: 4i .J <br />DATE At,rt�,, 1992 <br />Service Address 6511 hsit i;i^hlnnd Dr <br />Billing Address <br />1717II �:e.at ➢i� Lk Elvd <br />City, State, Zip t•t vernon WA 98273 <br />Owner Leif Rare�: <br />Connection by <br />Address <br />Phone _ <br />Legal Description: <br />Lo! <br />Block <br />Plat ���1�-f, 9g <br />Unplatted Description: <br />Type of Permit :.ew Connection <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259•8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utility Account No. <br />Permit Fee $ <br />Connection Charge <br />CHART NO. <br />TO POSTING l�-z9-�z <br />Trunk <br />Lateral <br />Totai Connection Charge <br />Utility Developmenl Fee <br />Water <br />Sewer <br />Total Development Fee <br />Sewer Bond Disirict <br />Abutting Lot Line <br />N,S,E,W — <br />Approved By _ <br />Issued By <br />Customer Signature <br />311.00 <br />$ 27e.00 <br />� 450.OD <br />$ 7�f1 00 <br />g ar,i.uo <br />� nHR nr <br />$ otn nn <br />� <br />Inspection By -���'l�� <br />Date Inspected �` -'`'' ` <br />INSPECTIOv <br />NO. 28677 <br />