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everett <br />� <br />City of Evere <br />SewQr <br />__ <br />1 <br />tt C L�i u r'.i �'��i ��� "�r—%. <br />� u;oo.s r <br />"; ^ `o Q. ., � <br />t ti � a � s .- _. <br />A�plicatio�t �and I��rm�at _ `' y <br />276Jr3 �_� ��:..'::;��� � <br />N0. DATE tenrch'? , ]y��o <br />Service Address_ 490fl - 9t# S,re S7 <br />Billin� Address_ ye �� 7gs <br />City,State,Zip lhikil*me un oa�75 <br />Owner (Mortgagor) c..i W�t u�„��,, r.,� <br />Billing Name a,.�„R+ <br />Connection By _ <br />P;�one 927 Bl9E . <br />DESCRIPTION: <br />Lot �a Block <br />Plat Glenkiaven Sts <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CAL L 1•800-424-5555 48-HOU RS <br />PRIOR T(. JIGGING <br />CALL 259-8871 FOR. INSPECTION <br />SEE SICETC;i ATTACHED <br />CHART <br />i o �'csT�N'� <br />g- g-<�� <br />u£�c�3� <br />�ur�^: <br />�< :� p] <br />%� <br />JY �Y .-t <br />�. <br />'+ L} <br />� ., <br />� ti � <br />�C—W <br />u� -1 <br />� � <br />Utility Account No. <br />Permit Fee�e�r_ <br />Connection Charg��s).��A 80 <br />Total Fee_ �„ ,,,, <br />ordinanco 1171-85 <br />wator 22ti.00 <br />sareer 589.00 <br />313.00 <br />Signed_ <br />Sewer Diatrict�g� <br />Monthly Sewer Service I10.00 <br />Monthly Sewer Constr. <br />Tru <br />Abutting Lot Line <br />N, S, E, N/. <br />Approved By arr.+�rn a ��r.ar. <br />Ciry Engiceer <br />Issued By_ <br />Inspection <br />Datelnspe <br />!i'.Sr,-C'� IOI�J <br />J iaockwell <br />�- i- s� <br />IVO. L7(,�� <br />� <br />