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1 <br /> CHART NO. <br /> everett <br /> �e�i <br /> City of Everett <br /> Sewer Application and Permit <br /> NO. 2 7 9 Q 9 DATE _ „ac_.1,, s — <br /> Service Adoress �tfs-�t8>—pi-5 Utility Account No. — <br /> Billing Address Latliall Umv 1.1i W29 <br /> City, State, Zip M11 Greek, VA M012 Permit Fee $ fi4tPH <br /> r <br /> OwnerConnection Charge 11117ik4911 <br /> Connection by Trunk 11-lAt 1} SXR-2, <br /> Address - Lateral iif U$ -41 in-on — <br /> 1, WI'll 4h.10 <br /> Total Connection Charg@•f,vA, i j L n (v, <br /> WM)6962 <br /> Phone Utility Developmert Fee I911CR 160.00 <br /> Legal Description: Water 11137 139 <br /> Lot3L_. _ Sewer I'M$ 1 al 00 <br /> 1171-'1 tt• :.It(1 <br /> Block Total Development Fee 1.111:I <br /> Plat _—R , �-s <br /> Unplatted Description: _ _ Sewer Bond District <br /> Abutting Lot Line <br /> N, S, E,W <br /> Type of Permit — hewb0flnection Approved By <br /> Remarks Issued By r. Rain <br /> Customer Signature <br /> IMPORTANTI <br /> CALL 1-800-424-5555 48-HOURS <br /> PRIOR TO DIGGING <br /> CALL 259.8810 FOR INSPECTION Inspection By <br /> Date Inspected 2"' VK <br /> SEE SKETCH ATTACHED NO. 27889 <br /> INSPECTION <br /> I <br />