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everen <br />e <br />city �r E�e�ett <br />Sewer Application and Permit <br />r�o. 24226 DATE '�2°�8� <br />ServiceAddress SO] 7/th 6trent s2x. <br />BillingAddress A�5 S.E. Evereet N 1 Kav <br />City, State, Zip F.v�rett, Na. _ 38204 <br />Owner (Mortgagor�Rillis nose��qc. <br />Billing Narne <br />S�ma <br />Connection Bv <br />Phone_— 3+�-�'�y2 _ <br />DESCRIPTION: <br />Lot_ 00 Block <br />Plat Var�lana Ertat�s <br />Unplatted Description <br />Type Permit: N�w Connoction <br />CHART NO <br />Utility Account No. <br />Permit Fee <br />Connrction Charge( <br />Total Fee <br />Signed <br />SEESKETCH ATTACHED <br />!':iFECTION <br />7G134-6 <br />30.00 <br />270.00 <br />30.00 <br />Sewe� District Dond II <br />Monthly Sewer Service 6. 50 <br />Monthly Sewer Constr. <br />Trunk 1.15 270.00 <br />Abutting Lot Line <br />N, S, E, W <br />Approved By A. R. Theal <br />Cny Engmcrtr <br />Issucd BV E. Boad <br />% i �L�� %^ ; <br />i���� � <br />Inspection By �'�" <br />C- ��I � <br />Date Inspected_ � � � l+ j � <br />N0. 24ZZ6 <br />