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everett CHART NO�� -2�I- 5 �
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<br /> City of Everett
<br /> Engineering & Community Services I J �j�'
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<br /> 5ewsr Application and Permit � J
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<br /> N0. l� ;� ', � i�� DATE '_L� i � _ I
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<br /> Service Address_ �'*< � O� �� Utility Account No. �
<br /> Billing Address Permit Fee '
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<br /> City, State, Zip _ Connection Charge�s) �
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<br /> Owner IMnrt�agn�� I otal Fee �� : . ...� I
<br /> Billing Name I
<br /> �l ' ` --f- �
<br /> Cci�nection By f .r• .� � �
<br /> Address__ � ' f • / %' �
<br /> Signed / � ����'r--�.--z. I
<br /> j Cuslamer �
<br /> Plione_ �
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<br /> DESCRIPTION: Sewer nistrict I
<br /> Lot_ Block_____
<br /> Plat _ Monthly Sewer Service I
<br /> Unplatted Description_ ___Monthly Sewer Ccnstr. ,
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<br /> Type Permit: ��,{,r_� ,4 �, , ,i,�:-- , • — Trunk i
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<br /> Lateral I
<br /> Remarks: �
<br /> —���1 Abutting Lot Line i
<br /> l_�t*£s a.r- G �� �s.i(,tzcp N, S, E, W---- --- _ft. �
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<br /> ��C��l��.-� �i, �/,.;T, -- �
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<br /> Approved �y � � +
<br /> ---' .__ l,ity Enginecr '-- ,
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<br /> ISSII@CJ BY ' ' �.;�� J/
<br /> T"-- I
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<br /> - -- . ---_-__ Inspection By_�-�ec�/ -� r, !
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<br /> i ----- Date Inspected� - 3 cJ - 7g' i
<br /> �`+� "'Kq� SEE SKETCH ATTACHED '
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