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m CHART NO. -- — <br /> b' everett <br /> aro <br /> e <br /> c, <br /> City of Everett <br /> TO POSTING 12 <br /> i�(rOQSyQ� Sewer Application and Permit <br /> ~ M <br /> o "m NO. 28690 DATE __Xr11_17. 1^92 -- — — <br /> Service Address 258i 59th fib gyF Utility Account No. <br /> —Billing Address 1.4410 An'.-Ped, PA 4200 — <br /> City,State,Zip X011 Permit Fee $ in nn <br /> Owner eouacrintoag n^-+n Connectlon Charge <br /> / ✓cM S /✓Ltr��r� <br /> Connection by py�A �7CT!�_ Truck $ <br /> Address Lateral $ <br /> Total Connection Charge $ -- <br /> i Phone Utility Development Fee <br /> C� Legal Description: Water $ <br /> 1 Lot 5 Sewer $ <br /> L <br /> J1 Block — Total Development Fee $ _ 32400 <br /> Plat —Poy3ar Hill Iliahlands <br /> _— Unplatted Description: Sewer Bond District -- — <br /> Abutting Lot Line <br /> N,S.E, W <br /> Type of Permit uma m,nrrrrTrwr Approved By <br /> _ Hemarks Issued By_7r�*m11 <br /> . ' IJ1 Customer Signature <br /> IMPORTANTI <br /> j CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> Inspection By <br /> CALL 259.8810 FOR INSPECTION <br /> Date Inspected 5 -��' ' S i <br /> SEE SKETCH ATTACHED N0. 286)90 <br /> INSPECTION <br />