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���' <br />ao�x <br />".�i H f~i� <br />��� <br />� H "�+J <br />fA H <br />� o� <br />HC <br />��8 <br />�r n <br />zH�yH <br />rHy <br />gy <br />OCN <br />��� <br />z y cn <br />H O p� <br />everett <br />� <br />City of Ever�tt <br />CHART N0. -- <br />T(� I�U�ifPt'G 7-��> 93 <br />_ 4���'.�F: � ����: <br />_ ' _�''." _ �:?�ti <br />�; � =�` ';: �6 .. <br />.. . .�i'. a:. CJ <br />Sewer �►p�lication �n� f�er�nit ��� :� ��? _ �:� {: <br />NO. 279Q$ <br />Service Address — .—=; <br />Billing Address — ' ' ' <br />City, State, Zip � <br />Owner — _ <br />Conneclion by <br />Addres, <br />Phone <br />Legal Description: <br />Lat <br />Block <br />f'18t -- <br />Unplaited Description: <br />Type of Permit <br />Remarks _ <br />J J <br />}Y, � _. C � '+y r ' <br />DAl'E _ _ / ,�/ ._..._�� = <br />� � <br />' % Utility Account No. — <br />�+ ! Permit Fee $ <br />Conneciion Charge <br />?runk $ <br />Lateral $ <br />Total Connection Charc�e n <br />___ — Utility Development Fee <br />Water $ <br />— Sewer g <br />— Total Development Fee $ <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-0810 FnR INSPECTION <br />SEE S�ETCH ATTACHED <br />Sewer Bond District <br />Abutting Lot Line <br />N, S, E, W — <br />Approved Ny — <br />Issued By <br />Customer 5ignature <br />ft. <br />I <br />Inspection By ��("��/Y' U`T I <br />3-IS'-�3 <br />Date Inspected � <br />I L� c; I' l-C�i I O iv <br />No.279C+i <br />