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everen <br />� <br />Cky o( Everott <br />Sewer Application and Permit <br />No. 25302 <br />Service <br />DATE <br />�a iacb naw �.s. <br />Bfllir,� Address 1�1� �W �~w �,�, <br />City, State, Zip �t��' �' �o1SS <br />Owner (Mortpagor) �O� ��' �' LO' <br />Billing <br />Connection <br />Address__ <br />o�,...... 7f�-0)li <br />CHART N0. <br />.., E.�� Fx.� l.�6�,c�n,ve <br />o�eob.: is, xses <br />Utility Account No. _ <br />Permit Fee_ �•� <br />Connection Charge�s) ��'� <br />Total Fee ��'� <br />orat�o. ii�i-es <br />Iht�t�178.00 <br />dwwr-�+1.00 <br />�!� �� f i��. <br />Signed � � <br />cmwmer —.-. <br />DESCHIPTION: Sewer District__ <br />lot = Block <br />p�e� q�r r,� Monthly Sewer Service <br />Unplatted Dexription__ __ Mocthly Sewer Constr. <br />TVPa Permit• Ilw Owrye�qp� <br />Remarks: <br />IMPORTANTI <br />C4LL 1-800 424-6665 48�HUURS <br />f'q10R TO DIOGING <br />CALL 769�8811 FOF INSPECTION <br />SEE SKETCH ATTACHED <br />Tru� <br />Lateral <br />Abutti.�g Lot Line <br />N, S, E, W. <br />IbwA liI <br />6,Sp <br />»0.00 <br />-----_._ ft. <br />A. 11. SMnI <br />Approved By <br />c�w e�p��em - <br />t. sad <br />Issuei Bv _ <br />�, <br />Inspection By G����\� <br />Datelnspected_��'�� <br />No 25302 <br />I'J::f'GG i,c�': <br />