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everett <br />� <br />City of Everott <br />Sewer A��plication and Permit <br />NO. 25896 DATE � ttove�r 3, 19e6 <br />Service Address_ 1321 12��rt1 St. SC. <br />Billing Address � <br />City, State, Zip vwzett, tn� 9820� <br />Owner (Mortgagor►_ u. C. Stapl;• <br />Billing Name s... <br />Connection By <br />Address <br />Phone <br />DESCRIPTION: <br />Lat Block <br />Plat <br />Unplatted Description __ <br />Typa Permit: Plea Goim^ctirn <br />Remerks: Nal:1 l�y �:C� 7:: MPc�rv•nt. t ti: <br />_ lnvoicc for si��e seWcr cn�stnn;t7nn (s1�p� <br />legul rrc;;crty �wm�c) ��:Purc 11/:J.l:G to: <br />[eli� SttcHr� - <br />3�.C�1� C�.l.�i �t. <br />Evrrett, �YA 912i+1 <br />IMPORTANTI <br />(:ALL tA00-024-5555 48•HOURS <br />PRIOR TO DIGGING <br />CALL 269A611 FOR INSPECTION <br />SEE SKETCH ATTACNED <br />CHART id0. <br />ia, 5 !� � — ��," -../J: f- <br />a !/-/C-iC� <br />� <br />��, �7 <br />�' � <br />;� ° � �� <br />�, <br />�: ������--; <br />U ; <br />^ �i <br />S � <br />Utility Account No. <br />Permit Fee ]0.00 <br />Connection Chargels) 330.00 <br />Total Fee 30.00 <br />Speclal Utility Fae, Ord. 1171-85� $100.00 <br />Signed <br />cu:mme, <br />Sewer District Cni�c Il: <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W <br />i�LF�tE:I; �i. rrin� <br />Approved By <br />Gry Enpinea <br />t;.�ru:+rr,t E. �`cL��u. <br />Issu�d Bv __ <br />Inspection (3y�_ , <br />7ate I nspected � I 1�� g <br />rvo. 25896 <br />INSPGC I IGfv <br />