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CHART N0. <br /> everet? � <br /> � -� SE..f To cyir�T�.,�� <br /> 'x �-2�- �% <br /> � I <br /> City of Evei ett � � � ..'�i �? �'3 '� � ? 3 ,: � <br /> i� � Yi :- '+ U7 Gt O 4• u �:� <br /> � r> M +� �'* r� -6 r• r.� i3 � <br /> � r� �n .n w ai :n t�i �G 'O <br /> Se�n�er Appqicatian and��rmity � � h � � :F <br /> . � , � �; , � � � _ <br /> ,r �. � �5 <br /> :;� - c, � %� �� -� � '� � .. � c� :� <br /> cr� G:: :v � Yi :� til lJ � ` :� = '�.�r - .-. ;.J <br /> N0. �`�0��� QATE c>�_�smhnr 1'/,�F_ ✓ <br /> � <br /> Service Address_ 120�� LBif��r' SE Utility Aa:ount No. <br /> Billing Address_.1792Q rt��A Aye NE Permit Fee an n� <br /> City, State, :!ip A___'r____1 tn,nrf_p�1�UA99'2 Connection Charge(s) �an nn <br /> Owner (Mortgagor) Ynn Ne�� Total Fee �� n� <br /> E3illingName $amp �r'd. 1171-R5 tdater 1i9.00 <br /> Se�aer 471 .QO <br /> Connection By 65Q.00 <br /> Address Signed <br /> Cus[omer <br /> Phone §�g�p�+� – <br /> DESCRIPTION: Sewer District R�n� iLI <br /> Lot_}� Block Monthly Sewer Service <br /> Plat <br /> Unplatted Description Monthly Sewer Constr. <br /> — - Trunk �zn nn <br /> Type Permit: <br /> Lateral <br /> Remarks: <br /> Abutting Lot Line <br /> N, S, E, W ft. <br /> � <br /> Approved By <br /> � Y . <br /> IMPORTANT! <br /> Issued By. Sue 6rannan — <br /> CALL 1-800-024-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 2595871 FOR INSPECTION ' <br /> Inspection By <br /> Date Inspected t2d�'` <br /> SEE SKETCH ATTACHEO No. 25833 <br /> INSP6C1'ICN <br />