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P. VC►!11 <br />� <br />City of Evarott <br />Sewer �pplicc�tion and Permit <br />�d. 2�+�i13 �ArE J•�. e, isss <br />us iacn n.e�. s,s. <br />Service Address. _ <br />1701• 1Slh Awatr �i,s, <br />Billing Address _ _ <br />B��ttl�, q�. �1SS <br />City, Statt. 2ip <br />Owner (Pl,urtgagor��� �� <br />Billing Name <br />Connection By <br />Address <br />Phone Mj��l� <br />DESCRIPTION: <br />Lot 6 _ glock_ <br />Plat �r � <br />Unplatted Description __ <br />Type Permit: M�wr <br />Remarks: <br />�MPOFiTANI'I <br />CALL i-BOOd2456ti6 48•HOURS <br />PRIOR TO DIGGIN6 <br />CALL269A811 FOHINSPECTION <br />SEE SKETCH ATTACHED <br />I CHART <br />".F.e.�/ TC CN..oe•r.,�G �(�/S�S4 <br />Utility Account No. _ <br />Permit Fee 30.00 <br />Connection Chargels) ���"� <br />30.00 <br />Total Fee__ _ _ ___ __ ____ <br />M�wr p�lap�nt !'a <br />e+din�+ee 1171—BS <br />11Rt:�r 17l.00 <br />8war 171.00 650.00 <br />Signed <br />custimer — � �— <br />Sewe� District <br />Monthly Sewer Service_ <br />Monthly Sewer Co�istr. <br />Trurk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W _ <br />8e�d III <br />l30.00 <br />-- ft. <br />■.R. �al <br />Approved By <br />crtr eoyme�, — <br />Issued By a� �� <br />Inspect�on By �"' ` • <br />Date I nspected Z��� G <br />No. 25403 <br />IfJ':; i �. i Il,i i <br />