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.e <br /> MR <br /> - k <br /> everett CHART NO. <br /> u 1 <br /> TnLe. <br /> E >38R $ 88 5 8 <br /> �y City of Everett <br /> y 3 Sewer Application and Permit <br /> n CA No. 284' 9 DATE <br /> z <br /> ty Service Address 14 6a[I. rl Sr. Utility Account No. <br /> W0g Billing Address 237 Fla <br /> 0. n <br /> z H City, State,Zip Everett VA 94203 Permit Fee $ 3p nn <br /> H <br /> r y Owner salecc t o..A Connection Charge <br /> gy <br /> t7y Connection by Trunk <br /> Address _ Lateral $ <br /> Total Connection Charge $ <br /> Phone Utility Development Fee <br /> Legal Description: Water $ in go <br /> Lot 7 — Sewer $ <br /> j1 Block _ ___—__ Total Development Fee $ 17000 <br /> Plat <br /> Unplatted Description: _ Sewer Bond District MUM <br /> t _ <br /> Abutting Lot Line <br /> N,S. E,W ft. <br /> Type of Permit flow connection _ Approved By <br /> Remarks _ _ Issued By G3 <br /> Customer Signature <br /> IMPORTANTI <br /> C j CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING � <br /> Inspection By — <br /> CALL 259-8810 FOR INSPECTION <br /> Date Inspected <br /> SEE SKETCH ATTACHED NO. 28429 <br /> hlshiscilord <br />