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everen <br />� <br />City of Evr.rett <br />Sewer Application and Permit <br />NO. GJQ�6 :ATE e�ew h.r ri. los6 <br />ServiceAddress »1� - 1�o h�— — <br />Billing Address ��� <br />City, State, Zip �co.rn�r_ ds oa�o� � <br />Owner (Mortgagorl ►�� n+ 9 <br />Billing Name <br />Connection By vf � r..= <br />Address <br />Phone i'+� �� �oorg�n) <br />CHART N0._. — <br />�rEn/T Tc C'i.•'�-'.''.< - // /7'r96 <br />n <br />i '� <br />4 <br />�, <br />.. :, <br />.. , <br />�,.����^ <br />.� <br />� �W- <br />� _ <br />U?iliry Ac�^ mt No. <br />Permit Fee <br />Connection Charge( <br />�• <br />330.00 <br />Total Fee �0.00 __ <br />Bpecial Utility Fee, Ord. 117]-O5� 5471.00 <br />Signed_ -- — <br />c�s�o�u, <br />DESCRIPTION: Sewer District eond rII <br />Lot Block Monthly Sewer Senice <br />Plat <br />Unplatted Description Monthly Sewer Constr. <br />Type Permit: <br />Nemarks: <br />IMPORTANTI <br />CALL 1-800-024�5555 48�HOURS <br />PRIOR TO DIGGIN� <br />CALL 259�8811 FOR INSPECTION <br />SEESKETCH ATTACHED <br />Lateral <br />Abutting Lot Line <br />N, .i, E, W <br />___ ft. <br />I APProved By I��RID R'i'tL-'*- -- <br />City En9inen <br />� Issued By_.����;�alo7wo�-- <br />Inspection By � �"!'e%"`�" --- <br />Datc Inspected ��- S" � — <br />No. 25952 <br />