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everen <br />e <br />City of Everott <br />Sewer Application and Permit <br />CHART <br />_'�.r7 iv "+'�ii:.u�_ <br />No. 25596 DATE �ori111.19e6 L <br />Service Address_ 3132 - S�tL sc sr Utility Account No. <br />Billing Address �=1 Bollovdal� Pl <br />City, State, Zip �rih• 1« 98201 <br />Owner (Mortgagor) ��d �• �Y <br />Billing Name_ <br />Connection By__ s� <br />Phone �� 3� _ <br />DESCRIPTION: <br />Lot 19 Block <br />Permit Fee 30.00 <br />Conc�ction Charge(s)— <br />Total <br />Sp�olal 7ea. Ozdinaacv 1181-75 <br />1tat�r 2:i.00 <br />_ <br />Signed ' _._'� ' � _ .. <br />customer—._.____�. '..-.. _ <br />'�� ,_' <br />Sewer District � ZI <br />Plat _ �--++---rty �iL f' �vionthly Sewer Service— �� <br />Unplatted Description _ Monthly Sewer Constr. <br />Type Permit: <br />Remarks: <br />IMPORTANI'! <br />CALL 1�800-024-5555 48•HOURS <br />PRIOF: : "' JIGuING <br />CALL 259�88?1 FOR INS?ECTION <br />SEE SKETCH ATTACHED <br />Trunk <br />Lateral �. <br />Abutting Lot Line <br />N, S, E, W, <br />Approved By xr.��n x 2�asr. <br />City Engineer <br />Issued By_._.�+�L MaL�od <br />Inspection By.,�/_ ��C//�� <br />Date l nspected G-/ 7- �G <br />No. 25596 <br />i PJSPECTI ON <br />