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everett <br />� <br />C.li�/ Oi EV@fBLL <br />Sewer Application and Permit <br />No. 25897 DATE ���W�r ��oi <br />Servir.e Address_ 22: 0 1; Otr, P: _ e F <br />Billing Address g�� <br />City, State, 2ip .+�.�.�� � on� . <br />Owner (Mortgagorl_KeSth �.trvr•n- <br />Billing.Vame �..� <br />Connection By��o= _ __ <br />Phone��9,,�n <br />DESCRIPTION: <br />Lot _ Block_ <br />Plat <br />Unplatted Description <br />Type Permit <br />��ew (:c�rlrxectini: <br />Remarks: pd.�/ ;:y LiU 71" <br />l.nwtce for si�k se�r consi <br />rt�� ur.nc: ) ;. �frr.� <br />Celia Sti�x�n <br />q <br />'. �:,� i,r�:+ac St, - <br />�w�rcr.t, r+q �,, c�1 <br />IMPOHTANTI <br />CALL 1�600-02M1�565548�HOURS <br />PRIOR TO DIGGING <br />CALL2598811FORINSPECTION <br />SEESKETCH ATTACHED <br />CHART N0. <br />s:-,�,- z- i; �, :.. :; i: - d,: <br />a <br />� <br />� K <br />Y•i �J <br />� <br />,� �����._; <br />_ - <br />Utiii[y Account No. __ <br />Perm�t Fee_ 3e.9B -- <br />Connec[ion Chargels) »0 QO <br />Total Fee �p q0 <br />Spacial tlt111ty Fce, OrR 1171-P5� $�00.00 <br />Si{�ned __ <br />CLSIO! <br />Sewer District__,,,R,.,_ <br />Monthly Sewer Service. <br />_ Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />Approved By �'� `_ i.� � . iI ,J <br />c��v e�o���n <br />IIssued By N•�n,�t� •. E_tk:l•'•-ri <br />� ' <br />Inspectian By � '� <br />Date Inspected�� �_ _ <br />rvo. 25897 <br />I:�i[Ti��: �li;; � <br />