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i <br /> �i <br /> i <br /> I CHART NO. --- <br /> I everett �� P�st'•^9 I <br /> - 5 - �s - 9i <br /> City of EvereN : � <br /> Y � <br /> � Sewer ap�lication �r�d Permit <br /> I ,,, ;: � �, <br /> NO. �`�.���� DATE �.,r�� 5, �om _ <br /> � Servlce Address � ip_p + Utility Account No. <br /> Billing Address " " " <br /> City, State, Zlp Permit Fee $ �� � <br /> Owner r•��•, T �cMi Connection Charge I <br /> Connectlon by _� — Trunk E <br /> I <br /> I Address .— Lateral $ <br /> �� _ Total Connection Charge $ <br /> � Phone Kp �g� Utiliry Development Fee <br /> Legel Descriptlon: Water $ <br /> Lot __ Sewer $ <br /> � Block Totat Development Fee $ <br /> Plat — <br /> � Unplatled Uescrlpllon: Sewer Bond Di;trict <br /> Atrufling Lot Line I <br /> I <br /> I N, S, E. W — fl. I <br /> � Type ot Permlt �t pplarrrrnx Approved By i <br /> i <br /> � Remarks ( -r� 73n) Issued By J qw�lrr�il <br /> I ,/ I <br /> ! _ _ Customer Signature� <br /> I I <br /> I IMPORTANT! I <br /> CALL 1-800•424-5555 48-HOURS �� <br /> � PRIOR TO DIGGING - - <br /> � � � �� � � � � <br /> CALL 259-8H10 FOR INSPECTION Inspection dy <br /> � Date Inspected __ �/`�� , <br /> I ' <br /> SEE SKETCH ATTACHED No. 282'�-s I, <br /> i i . ; � i ,� I <br /> i <br />