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CHART N0. <br />everett <br />� <br />- -__ : - � _. <br />Gty ot Evnrett - - - - <br />� � . �_ t= ; <br />Sewer Application and Pe�rri�t == � ` <br />;� - --_ _ _�- - <br />��_�rj:�_-;_ _- <br />N0. Z� �. 5 7 DATE =�isrsli.11,.1�31 __ <br />Service Address <br />Bllling Address - , - <br />Clry, State, Zip — <br />Owner �+s� <br />Connectionby .�:v�ere.`./ fi Fo�l�eRs <br />Address — <br />Phone <br />Legal Descriplion: <br />Lot 15 __ <br />Block _._ <br />Plat t <br />Unplatted Description: <br />Type ol Permit et�v o�� +on <br />Remarks _ <br />IMPORTANT! <br />CALL 1-600-424-5555 48-HOURS <br />PRiOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCIi ATTACHED <br />Utility Account No. <br />5��� � Po�,�,�y <br />� -z�,-�i <br />Permit Fee $ ��, tit� <br />Connection Charge <br />Trunk <br />Lateral <br />Total Connection Charge <br />Utility Devalopment Fee <br />Water <br />Sewer <br />Total Development Fee <br />$ <br />$ <br />$ <br />$ <br />$ 48A„A;,l <br />$ Sj'L.UO <br />Sewer Bond Disirict —_�- <br />Abutting Lot Line <br />N, S, E, W — fl. <br />Approved By <br />Issued By �+_,.,..,._. v_� _� <br />Customer Signature <br />Inspection By ��"� — <br />Date Inspected � ' 1 Y - `� ' <br />IbJGI'L(_� i IOId <br />No. 2$157 <br />i <br />