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„— <br />MEy"I <br />,O X x <br />Q H <br />9 H fn <br />y 3 <br />H �1 <br />oxo <br />i1HMt <br />xx U1H <br />ti7 O <br />O H <br />0. c� <br />aH <br />t” H <br />Hy <br />ndti <br />�M <br />Z30CA <br />C3 <br />�MOW <br />i <br />C3 <br />L1Q <br />�Wl <br />. <br />everett <br />,,e <br />City of Everett <br />CHART NO. -- <br />Sewer Application and Permit <br />NO. 28249 DATE __ l 1991 <br />Service Address 12 - 7Stlist cr Utility Account No. <br />Billing Address <br />City, Slate, Zip 4kks rrirkl• d wA 222 90o34Permit Fee $ <br />Owner oala-t.lcy^ <br />Connection by L �Z <br />Address 13]08 13Gth NR <br />Phone <br />Legal Description: <br />Lot 1 <br />Block <br />Plat ttidce I.ene <br />Unplatted Description: <br />Type of Permit now c^nneriion. <br />Remarks <br />IMPORTANT! <br />CALL 1-800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8810 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Connection Charge <br />Trunk h; 02i�'n+ <br />1•^'NIYYY 1eF19.1� t <br />Lateral gr1p <br />gg- <br />Total Connection Char I � <br />f540.00 <br />Utility Development Fee it clil <br />140.W <br />Water I.IK4. <br />I2iIt, nn <br />Sewer NA11S <br />tt M'W49 <br />Total Development Fee , <br />t-SEp* ^^ <br />1171 g <br />te50.011 <br />flim, <br />t1569.511 <br />Sewer Bond District <br />Abutting Lot Line <br />N,S,E,W — <br />Approved By -- <br />Issued By --_ <br />Customer Signature <br />Inspection By. — <br />Date Inspected <br />No. 28249 <br />ft. <br />INSPECTION <br />