Laserfiche WebLink
� <br />N <br />e��ret4 <br />� <br />City of [verett <br />Engineering & Community Services <br />Sev�rer e4pplica�ior� and Perrnit <br />�_: <br />NO. '.i. i:� I DATE ,. �� i <br />ServiceAddress �� ' � ? %���- �/✓ <br />Billing Address �� �a:'11.: <br />City, State, Zip � �'.- �:-� i��i . `j ;�0`f <br />� <br />Owner (Mortgagor) �1 �_ Nr��: E� � /y'� rvG <br />Billing Name_ `:� �i_-71-= <br />Connection By ' ' � � / - <br />Address _ <br />('hone 3_; � - n<> z �i <br />DESCRIPTION: <br />Lot <br />Plat - �' <br />Unplatted DescriF <br />CHART N0._ =� i ���� _ <br />; � <br />�� i <br />��� 5-��J <,� ; <br />Utility Account No. ' ``'t' - j/� ` `�%� <br />_.ti <br />Permit Fee_ 7�' <br />Connection Char3e�s) •' "" , F� ` �"�1���� <br />Total Fee �'U <br />( „ � . <br />_��, � <br />` irv ,�Ft/?,-:'� � ' < <br />Signed ' �_ <br />Custome <br />I <br />Sewer District '' � ''-y%' �-'' / �� � <br />Block <br />� , ., Monthly Sewer Service �� `'� <br />r <br />Month�y Sewer Constr. <br />Trunk � � <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Npproved By ' � _ <br />Ciry En9incer , � <br />. r: <br />c 0 � . <br />Issued [3y 't' � <br />. _ �G._ _'", <br />,�A, �.T,.:- <br />Inspectian By �Y�f-���=s��-��--� <br />Date I nspected� / 7� Z �_ <br />�/ <br />N0. <br />