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1 <br />everett <br />� <br />City of Evere++. <br />Engineering & Community Services <br />Sewer Applieation and P�rm�t <br />. ,_. <br />NO. e_ ! i_ U,) DATE 1 //•. � i l <br />: o I < �'� ' ;� .:.i • <br />Service Address—% - � ' � ' �'i <br />Billing Address� � % � `�� � /"L� � _ <br />City, State, Zip � .�' _ � �.?�2 � . , <br />Owner (Mortgago� • r '' % - <br />Billing N <br />Connection <br />�j%r✓�/�. •=/ ; : . <br />DESCRIPTION: <br />Lot X Block <br />Plat - ':� ' :.� <br />Unplatted Description <br />CHART NO.���"'a�1� _ <br />�o s ,,tL{,a . <br />�-�-�s' ; <br />�'� � . <br />Utility Account No. -� ' - <br />_ � <br />Permit Fee � �- <br />Connection Charge(s) �� ��'_ <br />.. n,�.. <br />Total Fee -'�� <br />u <br />— � _ -_. � <br />— � A^� / �� � <br />_ Signed �` �` r'` _� �' rL_ I <br />� <br />Customer <br />I <br />SEE SKETCH ATTACHED <br />i�ISi'i-rlili�;: <br />Sewer Distric[ <br />Monthly Sewer Service. <br />Monthly Sewer Constr. <br />. : <� <br />Trunk � r� r <br />L.ateral <br />Abutting Lot Line <br />N, S, E, W. <br />N _. ., <br />Approved B� • � <br />City.Engineer <br />I�sued By : - . - � <br />Inspection E3y_L._.L�� " <br />Date Inspected �� .? <br />N 0. �_ �_: , <br />i r. <br />