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everett <br />ciry or E�eren <br />,. �;, �I <br />�i� , ..�.. ., <br />Sewer Application an� Permit <br />NO. Z S Z Z 5 DATE <br />. <br />ServiceAddress � >>z�h ri cK <br />BIIIIngAddrebs —��q�;g�� h�r YI <br />City, State, Zip $rler ffR 98936 <br />OWnef F��E�rsFiio�et <br />Connection by <br />Address <br />Phone �i6 4�3i <br />Lepel Descriptlon: <br />�ot <br />B�ock <br />Plat . � <br />Unplatted Description: <br />TyPB Oi P9RTI�f Nw (bnnrn�inn <br />Remarka <br />IMPORTANTI <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH A7TACHED <br />Utllity A .�count No. <br />PermfiFee $ ��_ <br />Connectlon Charge <br />Trunk U4/;.'76'4���TIh (�hY1t� p�`r� � ; <br />Lateral ,yiyy�f;>�� <br />Total Connectlon Charp���j t� 3��� <br />Utilfty Development Fee � �' � �5 u'�''�'��� <br />Ii001)U7.^lTR <br />Water ���� �'�� <br />ur,�u-tx..� <br />Sewer '�F.1�f���-tq�� <br />(',t�)1[ "i`++ff:f�0 <br />Total Development Fee 1171t <br />Nf10Q07iYli � <br />hY1TCR 1111:�.0(i <br />Sewer Bond Distdct _�r�} ``' <br />�7E1 . • . <br />Abutting Lot Llne E�i�� � I #` w-�K� <br />11i1-5 i�:�.0(1 <br />N, S, E, W IUIQ��r��fl� ft. <br />IAITI:k tt(1'�.fq <br />Approved By unn^s�•�;� <br />��ku�.�� a���n.a� <br />Issued By , �h�t��� �"'y�� <br />Customer Slgna'• �re � � � � ' � �"p' � <br />�< <br />1kIlU' 91i15.Qp <br />1'I IC f.7: 9•i 4 A(1. (q <br />� <br />Inspection By <br />Date Inspected <br />irasr'GCTION <br />No. 28225 <br />