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everett <br />� <br />City of Everett <br />!R <br />i5ewer Appli�ation and Permit <br />I N0. 26�4 f 1 DATE v-(^> L'-i/ <br />� " <br />Service Address I� /_ ' � <br />Bfllir�g Address P• O. IIo:c 592 <br />City, State, Zip Lk Steoens, '+Tn 90258 <br />Owner (Mortgagor) <br />� <br />!!nlur.t s S�ith <br />Same <br />Connection By Same <br />Address Same <br />Phone 653-2Q25 <br />DESCRIPTION: <br />Lot 19 91ock <br />Plat Lar�on Place <br />Unplatted Description <br />Type Permit: <br />Remarks: <br />IMPORTANT! <br />CA L L 1-800-024�5555 48�H0 U R S <br />PRIOR TO DIGGING <br />CALL 259•8811 FOR INSPECTION <br />SEESKETCH ATTACHED <br />CHART N0. <br />` f,>„ ^� � <br />�� � � -a •� <br />� C� C <br />Utility Account No. <br />Permit Fee 30.00 <br />Connection Charge�s) 330.00 <br />Total Fee 30.00 � <br />Special Utility Fee <br />water l78.00 <br />serrer 471.?0 <br />ESD.00 <br />Signed <br />Cusmmcr <br />Sewer District Bond 2II <br />Monthly Sewer Service_ <br />Ord. 1171—IIS <br />Monthly Sewer Constr. <br />�' f6t ����:��1;;• ,,. �, <br />Trunk '+;O.ro <br />�:: ;. . .;•, t <br />Lateral ;1;Ti_ <br />I>liiii 1 I . _:i,li.P.�t <br />Abutting Lot Line�i',': ', ;�,';�I:.i�,; <br />N S E Wi)atiUi'S,'•,i:' ft. <br />�:,,:E:' ;;�t;,�,:� <br />,_1��;::�:,. ;;g <br />�iI!�, . -q�,Jlij <br />i : L�. . I'.i.i,l) <br />Approved By n'r.��Fn a_ � mt'rtr�r. <br />;.'CIryi6Q9inecr „':i�l <br />�. ;:`'I_(! �; I.�.I�i.i <br />Issued By R'�y ur.;gbr}��! <br />U�. .. : ].'i';;.Uli <br />!nspection By� <br />Date Inspected � �S lf� <br />No. 26�71 <br />