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everen <br />e <br />City of Evere <br />Sewer <br />^ <br />:. <br />$ <br />tt � ���a�8 ��S 3� <br />� ��.�]j c ❑ p�,^/ 4 C, <br />.a.," "` � "'�� �',�,il, <br />Applicatig��nnnc��Er�i#, � �" <br />� <br />?Tj C�C W rS� �a'R`-�3�.'�..�e'RJ:3 <br />27�63 " �r3s"?=o�� �� ���� <br />N0. D�ATE <br />Service Address <br />♦917 9th 71ve. W. <br />Bi�ling Address <br />P.O. Box 708 <br />City, S!ate, Zip <br />hnkiltoo, ffA 98275 <br />Owner (Mortgagor) <br />Select ftases <br />Billing Name <br />Sa�oa <br />Connection By <br />Same <br />Phone <br />DESCRIPTION: <br />Lot <br />$aI11C <br />827-819G <br />Block <br />Plat �},�v�n-�i�#ghts <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />Nev Connection <br />IMPORTAPJT! <br />CALL 1-800d24-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEESKETCH ATTACHED <br />CHART <br />�Tu t�STlni�, <br />�.a.�o <br />TO POSTING "�' 1 � ��� . <br />Utility Account No. <br />Permit Fee gg,66 - — <br />Connection Charge(s) �}9.99 <br />Total Fee +� �.. <br />Utility Developmsat Fee Ord. 1171-85 <br />vat�r 179.00 <br />sewz /71.00 <br />' ;650.00, <br />Signed —' <br />cu:tomer <br />Sewer <br />EST�f_� <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />].10. 00 <br />Laterai <br />Abuttiiig Lot Line <br />N, S, E, W. <br />Approved By <br />ALlkE6^90FeTAS11L <br />issued By <br />Inspection By -r"V`�" <br />Date Inspected S-��/`�� <br />No. 27463 <br />INSPECTION <br />