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everen <br />� <br />City of Ever• tt <br />Sewer Applicafiion and l�ermit <br />CHART <br />Sc,vr �<, , �. r�.,c— <br />No. 25945 DATE _ _ � <br />Service Address ' � • Utility Account No._ <br />8illing <br />City, State, Zip / <br />Owner (MortgagorL �:, ��PC !\ �1) !L/A� <br />Billing Name ���P _ <br />Connection <br />DES(,RIPTION: <br />Lot <br />Plat — <br />Block <br />// / vc- <br />Permit Fee <br />�� <br />Connection Charge(s)_ �� <br />1�� _:2JFN U(41AN�' ,'; ! f f { <br />Total Fee � . <br />NUIJI�".iY55 <br />SF_IAF t�I.0i1 - <br />i»�U 1- s ;�0.11(l <br />11 i I-'� 44p(1.0(7 . <br />li(IUtkl'i;i�Q <br />Signed __ iN•i.:'n 'f^ilvi.tit <br />�Y�91"la`, 9:;i�'�I.(i4 <br />Sewer District ,'��/V �— <br />Monthly Sewer <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Remarks <br />IMPORTANTI <br />CALL 1�800-024�555548�HOURS <br />PRIOR TO DIGGING <br />CALL 259A811 FOq INSPECTION <br />SEE SKETCH ATTACHED <br />Abutting ! ot Line <br />N, S, E, W, <br />Approved By <br />ciry Enpineer <br />Issued � <br />. <br />Inspection By <br />Datelnspected �� ��� <br />1�2:;i'CCIIUi�I <br />Na. 25945 <br />