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everett <br />I� <br />�I{ � <br />j City of Everen <br />�<--,, _ ,�� <br />.� <br />1� C; � t -_ - <br />�l`-�'��' �� ��1 <br />(?�-(�' <br />Sewer Application and Permit <br />No.23891 DATE <br />z,��,a� <br />806 1► 6 B 55th Placa S.N. <br />Service Address <br />21B Aighland Aoad <br />Billing Address <br />Evaratt, Na. 98203 <br />City, State, Zip <br />Owner (Mortgagor) Blak�lp Cnap Hoa�s <br />Billing Name <br />Sae• <br />Connection BY s��� <br />347-1747 <br />ias�n-o <br />Utility Account No. — <br />30.00 <br />Permit Fee <br />DESCRIPTION: <br />Lot � Block <br />Plat _ Ea�t 80' o! Tr�ct 11 E��s�tt Aa�l• <br />Unplatted Description <br />.' _ ..___... w.r mne�ctioA <br />773.�60 <br />Connection Charge(s) <br />30.00 <br />Total Fee <br />Ordlaanca t722-80 <br />Arna 5 850.00. <br />/� <br />i' ' <br />;Ji ; <br />, �- �; ; <br />Signed ` <br />Customer <br />34 BoadIII <br />Sewer District <br />M�et�r�d <br />Monthly Sewer Service_ <br />Manthly Sewer Constr. <br />SEE SKETCH ATTACHED <br />' I INS?ECTfON <br />Trunk 2•�� 35�.00 <br />4butting.Lot Line <br />�N,S,E,W, <br />2.96 <21.60 <br />80 <br />A. R. Theal <br />AppfOV2d BY- City Engineer <br />B. Sond <br />Issued By <br />Inspection By <br />Date 1 nspected Z � ✓��y �g�� <br />No. 23891 <br />