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CHART NO.�`�- "- / � <br /> everetl <br /> e ' �_ � �� � �� <br /> � � � � <br /> City of Everett <br /> Engineering & Community Services �� • <br /> Sewer App►lication and Permit ; �� <br /> N0. . , DATE , � � , <br /> --- -- +._ , <br /> Service Address �� '��� ��- �• � r' � � __ Utility Account No. _ <br /> Billing Address G'S' �" � -�� `�� L Permit Fee ��`� ' � 'l <br /> City, State, Zip � L � �� i� � t-•�� 1 . Connection Chargels) _ <br /> i <br /> Owner (Mortgagor� __ Total Fee r'I� ''-' E- � <br /> Billing Name <br /> Connection By � ' r � 4 C �- �. �.i' c..��- <br /> i <br /> Address_ Signed ` -L-c_.�c_. '.-.r..• [: � n�� � • ! <br /> c�,�umer <br /> Phone_ _ i <br /> � <br /> DESCRIPTION: Sewer District_. _ � <br /> Lot Block I <br /> Plat Monthly Sewer Service _ <br /> � <br /> Unplatted Description _ _____ Monthly Sewcr Constr. � <br /> i <br /> I <br /> Trunk I <br /> Type Permit: � <...1 � � � iG. � <br /> Lateral I <br /> Remarks: <br /> Abu[ting Lot Line � <br /> _ c ft�� �9 �r �'—, i'.�.� . . . f�. � _ N, S, E, W f[. i <br /> � . .. a � <br /> �� sLL � I <br /> � <br /> i <br /> — — APProved By � I I L r �, � � . c .� _ � <br /> _ cnv Enyioee. '� <br /> —. _ � <br /> -- - l � � <br /> Issued By �� ��� < < � " �� ti-J <br /> --- � <br /> _ _ i <br /> --- ' <br /> Inspection By_�' '� - lf , <br /> u <br /> - --------._.------ iDatelnspected '�✓ �t_,_h.c�_ ' <br /> SEE SKETCH ATTACHEU N0. <br /> ... .. � �. . , , � . a . . , ..:... . ., . � ''�� <br />