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��� <br />D � x <br />C H <br />�Htn <br />y�H <br />K f) <br />7C <br />"�+]hi� <br />NN <br />x <br />o�d <br />H�g <br />4] � c1 <br />H <br />zH <br />�yH <br />n�y <br />�H[n <br />HO(n <br />� <br />� �� <br />� <br />� ,=� <br />everett <br />� <br />City oi Everett <br />Sewer Application and Permit <br />N0. Z H I.7 Z DATE __ ;:�,F��yi:T-���i--- <br />ServiceAddrecs _J�:=_-1�[l:_5[-�t±-- -------- <br />Billing Address —::+.� - <br />Ciry, State, 7ip —��-} - <br />Owner � �-2irr <br />Connedion by =� ^ "" <br />Address <br />Phone :lS�-9'�12 <br />Lngal Descrip�ion: <br />Lot � <br />Blocic -- <br />Plat --�:icti'�-t,mp <br />Unplatted Descrlption: __ <br />Type of Permit ��,,,,�ariw:-- <br />Remarks — <br />IMPORTANTI <br />CALL 1-B00-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Utilily Accounl No. <br />CI IA13T NO. <br />� m nncnNr, ?�i�/q� <br />70.U0 <br />Permil Fee $ . <br />Conn�ction Charge <br />Trunk $ <br />Lateral $ — <br />Total Conneclion Charge ' $ ' � <br />:_•.d't1�K�dl�,r,i: it. � <br />Uliliry Dovelopmem Fee """� � '' � � <br />:Idl .-.�,�1.'..0 <br />Water � � �s� _r�'���M,o ��— <br />iJiH )'y.l.i�� <br />Sewer iqp SI+—�--.-D-�� nn <br />I.{!M1Y; �: U.inl <br />Total Development Fee �; .a��, , , <br />I. 'dr'H �� .,rl.�i � <br />1: `�bl'.II ��..'�� <br />,.ilUO,P�... �tr, n r Hrn:•1 <br />SewerBondDistrict }��. . ��� � <br />Abutting Lot Line I �'71 ', � :����.�"i <br />il'tlnxl'i I::'. ft. <br />N, S, E� W— �� µ�; :-u.+w----- <br />11YJ 1 l i ��. . .•'�: <br />Approved By — <br />Is^•ued By r++rrArut HcLend <br />Customer SignaWre <br />Inspeclion By _,C�" "f ` <br />Date Inspected —'—�'- � =�-- <br />n� ;,�: � �� iu�� <br />NO. ZA1�IL <br />