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! , ` f <br /> CHART N0. <-' 4 �_ . i . ; <br /> evereft <br /> c ��O S ��` .G7 <br /> E e -�� _� <br /> � t <br /> City of Eve�ett " ' <br /> Engineering & Community Servicas �� <br /> Sewer Application and Permit �. <br /> � . <br /> NO. -'_�_ Ei � ;; DATE f�/:�7J <br /> Service Address � y--r� i Utility Account No. �' � =� - , v%r - �{' <br /> ,. ,� <br /> Billing Address -'JJ - r-���'� � / l % — Permit Fee -%L' <br /> -� t.:..-- <br /> City, State, Zip�---��+.�- ;.� ��, - ✓� / ' -- ��-' . Connection Charge�s) :-3 '% G' <br /> � :J�.-. <br /> Owner (Mortgagor)f�'� ' - ' ' `" �---• Tctal Fee -.J'> <br /> Billing Name :'�' -> •. `-'-' _ <br /> Connection By '" � -�----- <br /> Address _ _ Signed -�C r � "� �� � <br /> Cusmmer <br /> Phone % > J -" L''J�� '"� <br /> DESCR/IPTION: Sewer District ^ � <br /> � Lot,/ "� ^c Bls�ck .� </ : <br /> Monthly Sewer Service ^� � � U <br /> Plat J�, l' t�,-�- _ T�'_ <br /> � Unplatted Description MGnthly Sewer Constr. <br /> � _.-.- Trunk �' �`-' <br /> � TYPe Permit:7f: ;�:�- _ / , _ <br /> Lateral <br /> € Remarks: <br /> � Abutting Lot Line <br /> N, 4. E, W ft. <br /> � � . APPraved By��� ,<.%'� . <br /> f City Engineer � <br /> �` . � <br /> Issued By�'` <br /> f{ <br /> ! -- — <br /> � Inspection By.� -��� � —> <br /> f <br /> ` _ Datelnspected�/S�7 � <br /> t y - <br /> i <br /> ` SEE SKETCH ATTACHED �' N0. <br />