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" <br />, � <br /> � y <br /> �,�y pC _«. <br /> I-i <br /> >H!n <br /> I~���K <br /> ��� CHART NQ. — <br /> �y� everett � <br /> z ,,-. <br /> �d -= <br /> ��g rett � � ��:.LL j � � � � ` s: T� P�STING � <br /> � y� CltyofEve ;,.. . "., .. � f �., n � �r /7/ / <br /> H H :` = �`. ' '� f ` , : <br /> �y • ' r• ` � . • <br /> �9dy Sewer AppliEa�`�ion � P'errr+lt <br /> P] r b� U � r - J �,d ���� � W <br />� �� R �. � � L � � 2 x :' � r _ <br />� ��' NO. 2 H�.a� DATE ��,,__._r-'-s. ,oo, I <br /> Service Address —_ Utiliry Account No. " <br /> Billing Address �-�t----- <br />' City,State,Zip . — Permit Fee $ °^ �� — <br /> Owner -- �"-' r�� Connection Charge <br /> Connection by Trunk h <br /> Address Lateral � <br />, _ Total Conneclior Charge $ — <br /> ' 1 Phone _—>4a gs�a — Utility Development Fee <br /> ��' Water $ ��^ ^^ - <br /> Legal Description: <br /> ' 1 Sewer $ a7i no <br />, Lot <br />' ��� Total Development Fee $ 650.00 <br /> 01ock <br />, � <br />� �I PI81 Kthri- Z2t <br />, '� Unplatted Description: Sewer Bond District <br />; '�' Abutting Lot Line <br /> � ' N,S, E,W h' <br /> � <br />'� � Type of Permit u �io _ Approved By <br />;' � Remarks Issued By <br /> � <br /> tCustomer Signature <br />� � IMPOR7ANT! <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING G ��� <br /> Inspection By <br /> CALL 259•8810 FOR iNSPECTION .� � D <br /> Date Inspected � <br /> SEE SKETCH ATTACHED NO. Zg1�3 <br />' u��s��c t��o;�! <br />