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CHART NO. _ <br /> I everetl i <br /> � I <br /> � <br /> :� <br /> �a <br /> ,,� <br /> 3 <br /> City of Everen � � � � r�, � <br /> �� � � � � '� � <br /> .� .' w <br /> � � � <br /> Sewer Application and Perm�] , � � � <br /> � � 1-� $ � � � �� W � <br /> 26597 � °� � `� � 3 � � � <br /> NO. DATE �.++�� �t� t`�. <br /> Service Address �427 1pptA Ce iM 1570 Utility Account No. <br /> BillinQ Address 1427 - 100th St SN d170 Permit Fee 10.00 <br /> City, State, Zip �=+tt, NA 9820� Connection Chargels) <br /> Owner (Mortgagor) d � o� �l�l 1"otal Fee_ 10.00 <br /> Billing Name <br /> B� � <br /> Connection By _ <br /> Address _ Signed <br /> Cuttamer <br /> Phone I <br /> I <br /> DESCRIPTION: Sewer District_ iend iz2 � <br /> Lot 110 Block i <br /> Plat Monthly Sewer Service <br /> -aor–t�ark , <br /> Unplatted Description Monthly Sewer Constr. I <br /> Typa Permit: Trunk <br /> Nw oo�uwctim �obil� � <br /> Lateral <br /> Rernarks: <br /> — Abutting Lot Line <br /> N, S, E, W__ ft. <br /> i <br /> � <br /> Approved By ic.�nen n_ �nreir. ' <br /> CitY EnpineM ! <br /> IMPOPTANTI � <br /> CALL tA00d24•6655 48�HOURS IssuCd By wr�aert R Mnrr�A ; <br /> PRIOR TO DIGGING i <br /> CALL269-8811 FOR INSPECTION i <br /> Inspection By <br /> Datelnspected_ I <br /> SEE SKETCH ATTACHED No. 2659 7 � <br /> I <br /> , . �r� `i �� � . � <br /> I <br />