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CHART NO. <br /> everett '" <br /> y e J TO POSTING_ <br /> m <br /> City of EverettE7 $$ $ g - <br /> C H <br /> Qqo Sewer Application and Permit <br /> NH - <br /> NO. 8 3�g DATE _July -u, inel — <br /> OH <br /> = 08 Service Address 131,-.6nth-P1-"---- - Utility Account No. — <br /> �Y n <br /> z H Billing Address - r% 4010 -- <br /> gH <br /> y y City,State,Zip —���, gg�------- - Permit Fee $ +^ ^e <br /> O o y Owner u&n&b=ok Tlac --- Connection Charge <br /> jmy Connection by Pomer.C� ' V.I.o. . �a`,Itllut=— <br /> Trunk $_ <br /> y O m Address Lateral $ <br /> _— Total Connection Charge $ "n <br /> Phone __ -- Utility Development Fee <br /> rr Legal Description: Water $ L7p On <br /> L Lot 51 -- _----- Sewer $ <br /> Block ----------- Total Development Fee $ 179.00 <br /> Plat m.--AM------- -- <br /> Unplatted Description: _ _- Sewer Bond District vran 11 <br /> Abutting Lot Line <br /> - -- -- N.S.E, W <br /> LID Type of Permit __ Approved By <br /> ' Remarks _ __ Issued By—greekiii 11 <br /> Customer Signature <br /> IMPORTANTI <br /> 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. 28368 <br /> Ir1SPFCII0N <br />