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CHART NO. _ <br />everett <br />e <br />City of Everott <br />Sewer Application and Permit � <br />No. 25429 DHTE lh7/!f <br />Service Address i�a SLt llao� i.x. Utility Account No. <br />Billing Address u30� !!A uao� 1Mt <br />City, State, Zip ���� �� �� <br />Owner (Mortgagor► �s�� ��� _ <br />Billing Name _. <br />Connection By — <br />Address _— <br />Permit <br />Connection Charge�s)_ 270.00 <br />Total Fee �•� <br />Osdiaanw f11�1�65 <br />MaL�r 279.00 <br />�wr �71.00 <br />�50.00 <br />Signed'1 � %" �: <br />��w'°na` , <br />Phone ��-1637 _ <br />DESCRIPTION: � � Sewer District �d I= <br />Lot � Block <br />Plat .��i... Moi�chlySewerService�..i�1 <br />Ca�N�Cl�o <br />Unplatted Description Monthly Sewer Constr. <br />Permit: <br />Rkmarks: <br />IMPORTANTI <br />CALL 1�800�124-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL259S811PORINSPCCTION <br />SEE SKETCH ATTACHED <br />Trunk 270.00 <br />Abutti�g Lot Line <br />N, S, E, W <br />Approved By w• �• �1 <br />CitY EnqineM <br />Issued By �• �� <br />-��`/�---- <br />Inspection B � <br />Date I nspected � ' � �' � � <br />Na. 2sa2s <br />INS?ECTION <br />